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Finding legitimacy for the role of budget impact in drug reimbursement decisions

Published online by Cambridge University Press:  06 January 2009

Maartje G. H. Niezen ,
Antoinette de Bont ,
Jan J. V. Busschbach ,
Joshua P. Cohen  and
Elly A. Stolk
Maartje G. H. Niezen
Affiliation:
Erasmus MC
Antoinette de Bont
Affiliation:
Erasmus MC
Jan J. V. Busschbach
Affiliation:
Erasmus MC and De Viersprong
Joshua P. Cohen
Affiliation:
Tufts University
Elly A. Stolk
Affiliation:
Erasmus MC
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Abstract

Objectives: Research has shown that effectiveness, cost-effectiveness, and severity of illness each play a role in drug reimbursement decisions. However, the role of budget impact in such decisions is less obvious. Policy makers almost always demand a budget impact estimate yet seem reluctant to formally include budget impact as a rationing criterion. Health economists even reject budget impact as a legitimate criterion. For these reasons, it is important to examine its use in rationing decisions, and rationales underlying its use.

Methods: We trace several rationales supporting the use of budget impact through a literature review, supplemented by semistructured interviews with eleven key stakeholders involved in drug reimbursement decisions in the Netherlands.

Results: Budget impact arguments are used in certain instances, although policy makers appear uncomfortable with its use because well described rationales still are lacking. In addition, we identify the following rationales to support budget impact as a rationing criterion: opportunity costs, loss aversion, uncertainty and equal opportunity.

Conclusions: Budget impact plays a role in drug reimbursement decisions and has rationales to support its use. However, policy makers do not easily admit that they consider budget impact and are even reluctant to explicitly use budget impact as a formal criterion. A debate would strengthen the theoretical foundation of budget impact as a legitimate criterion in the context of drug reimbursement decisions. Such discussion of budget impact's role will also enhance policy-makers' accountability.

Keywords

Pharmaceutical policyHealthcare rationingBudget impactThe Netherlands
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 1 , January 2009 , pp. 49 - 55
Copyright
Copyright © Cambridge University Press 2009

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