The Dutch Healthcare Institute (NZa) has scrapped certain expensive cancer inhibitors from the basic health insurance package for specific patient groups. New international research shows that these medicines, called PARP inhibitors, are not effective for these groups in increasing their life span or the quality thereof, the NZa said.
The measures will impact people with advanced ovarian cancer who do not have the BRCA mutation in their genes and people with metastatic breast cancer. People with advanced or recurrent ovarian cancer who do have the genetic error can still receive the medication. The inhibitors are effective for them.
The measure is effective immediately. Health insurers have a transitional arrangement for affected patients. Patients who are already undergoing treatment with a PARP inhibitor can complete the treatment, and the health insurers will reimburse that care. For patients who have not started treatment yet, reimbursement will stop immediately.
According to the NZa, around 1,000 patients in the Netherlands use PARP inhibitors each year, costing over 30 million euros per year. The number of users will be halved by this decision. The money that is released can be used for other care.
This is the first time that the Netherlands has partially removed an expensive medicine from basic health insurance after reassessing it, according to NOS. The decision stems from the Integrated Healthcare Agreement, in which doctors, health insurers, and patient organizations agreed on ways to get the exploding costs of healthcare under control.
Cancer treatments, specifically, are very expensive. In 2012, the Nehterlands spent over 1.1 billion euros on medicines for all treatable conditions. 27 percent of that amount was for cancer medicines. By 2021, that share had risen to 59 percent, and the total costs of medicines had grown to 2.6 billion euros. At the same time, life extension had hardly increased.
The Dutch Society for Medical Oncology supports the reassessments, but wishes the NZa had based its decision on better studies. “The new studies are not very strong in quality,” chairwoman An Reyners told NOS. “For example, certain patient groups are not properly defined and are not properly included in the statistical analyses. This means that there is indeed no evidence that a treatment is effective, but it is also difficult to prove that the treatment is not effective. Then there is a risk that certain patients will wrongly no longer receive this treatment.”
The Dutch Federation of Cancer Patient Organizations thinks that the NZa places too much emphasis on the average life span gain for the entire group of patients and not enough on the quality of life.
NZa director Lonneke Koenraadt-Janssen acknowledged that she would have preferred more sources to base the decision on, but information like practice data on the effectiveness of a drug for Dutch patients proved completely fragmented and unusable. “So then you have to make do with the available information. And that lacks sufficient evidence that the PARP inhibitors work well for these patients,” she told the broadcaster.
She added that the NZa paid specific attention to the inhibitors’ effect on patients’ quality of life. “In the research data, we saw no improvement in quality of life. We saw that it was no better in patients with PARP inhibitors than in people who received a placebo or chemotherapy.”