PhD defence J.J. (Joost) Enzing

Below is a brief summary of the dissertation:

The content of the basic benefit package (BBP) is restricted to contribute to affordable, accessible, and good quality healthcare. Setting boundaries to the BBP involves evaluating the costs and benefits of healthcare interventions. Decision-making frameworks based on health technology assessment (HTA) have been developed to support this process. However, these frameworks are not yet optimal, primarily used for decisions regarding pharmaceuticals rather than other healthcare interventions. A more systematic evaluation of the latter can significantly enhance the affordability, accessibility, and quality of healthcare. This thesis aims to optimize decision-making frameworks by examining two themes: broadening the scope of HTA by adding "profitability" as a decision-criterion and extending the use of HTA to other healthcare interventions.

Analyzing reimbursement reports for expensive pharmaceuticals revealed that HTA organizations did not consider the costs incurred by drug manufacturers in relation to drug prices. The study also investigated if policymakers incorporated information on profit margins in hypothetical reimbursement decisions, and it was found that higher profit margins reduced the likelihood of reimbursement. Thus, "profitability" should be seriously considered as an additional criterion.

Additionally, the challenges that Zorginstituut Nederland might encounter in expanding the use of HTA were explored. Five characteristics of pharmaceuticals that facilitate HTA were identified, and challenges related to these characteristics were assessed for five other healthcare interventions. The multitude and complexity of the identified challenges, along with their variation among healthcare interventions, emphasize the need for prioritization while transitioning to a broader use of HTA.