Disease models for insured package management

The National Health Care Institute is working on the development and use of disease models for insured package assessments. Disease models allow the consequences of a treatment to be estimated in the longer term. The aim is to be able to assess the added value of new treatments better and faster. The National Health Care Institute expects to complete the first package assessment based on a disease model in 2024.

A better understanding of the consequences of treatment in the longer term using disease models

A disease model is a mathematical description of a disease and its treatments. A disease model helps clarify the long-term consequences of treatments.

Disease models can help with insured package assessments

The National Health Care Institute advises the Ministry of Health, Welfare and Sport (VWS) about reimbursement of medicinal products and treatments through the basic health insurance package. Disease models can help us do this. Using a disease model, we look at whether medicines and other treatments have a long-term effect on a patient's health. The model also makes the costs of a treatment clear. We refer to this as assessing the effectiveness and cost-effectiveness. This lets us compare a new treatment against an existing one.

Using disease models to compare existing and new treatments

In a package assessment, we compare the new treatment against the existing one. When doing so, we look at which treatment and treatment sequence is most effective. A disease model allows all existing and new treatments for a disease to be evaluated and assessed at the same time and in the same way. This allows a proper comparison to be made. A disease model is innovative because it also takes account of follow-up treatments.

Research into a new approach for assessments of medical treatments

In October 2022, the National Health Care Institute started a project called ‘Doorontwikkeling pakketbeheer: Implementatie gebruik ziektemodellen’ (Further development of insured package management: implementation and use of disease models). This project is running for 3 years. In it, we want to learn more about developing and applying disease models. The aim is to make sure that the medicinal products prescribed are above all those where the cost of the medicine is suitably proportionate to the health benefit it provides.

Disease models have now been developed for melanoma (skin cancer), multiple myeloma (MM) and diabetes. The data requirements, policies and organisation for developing and using disease models have also been investigated.

The project is developing two more new disease models and working on methods for making the lessons learned from such models usable for insured package management.

We expect to issue the first package advice based on a disease model in 2024.

International collaboration

The National Health Care Institute collaborates with organisations doing similar work to them in other countries, such as NICE in Britain and CADTH in Canada. These countries are also looking for options for using disease models in their insured package management. Working together will let us learn from each other’s experiences and it will be possible to exchange disease models.

Stakeholders

The Ministry of Health, Welfare and Sport (VWS)
Development of a disease model for type 2 diabetes – Rijksinstituut voor Volksgezondheid en Milieu (RIVM, the National Institute for Public Health and the Environment)
Development of disease models for melanoma and multiple myeloma – Erasmus School of Health Policy & Management (ESHPM)