Zinnige Zorg room for improvement report - Appropriate use of pharmaceutical products for patients with castration-refractory prostate cancer (CRPC)

Within the framework of the Zinnige Zorg Programme, Zorginstituut Nederland systematically assesses the Dutch minimal and mandatory package of health care that Dutch health care insurers must provide. There are four phases to this systematic assessment: screening, in-depth assessment, implementation and monitoring. In 2015 we published a screening report: ‘Systematic analysis of neoplasms’. During the screening phase, one of the topics mentioned by the parties for in-depth assessment was ‘appropriate use of pharmaceutical products on people with castration-refractory prostate carcinoma (CRPC)’. The aim of the in-depth phase is to gain insight into the potential for improving the use of pharmaceutical products. We engaged an external party to carry out research into possibilities for appropriate use of pharmaceutical products on these patients.


Castration-refractory prostate carcinoma (CRPC) is the final phase of prostate cancer. The disease has generally spread by then. Curative interventions are no longer possible. Treatments are therefore palliative in nature, with the main goal being retaining or optimising quality of life. Oncolytics are generally used in this final phase of the disease. The treatment arsenal for patients with CRPC has grown considerably during the past decade. There is a lack of clarity about the choices underlying the use of these medicines to realise the greatest effectiveness in relation to adverse effects.

Room for Improvement Report

Research has shown that it is possible to arrive at more appropriate use of medicines based on:

  • appropriate diagnosis
  • good harmonisation between care professionals
  • reduced use of active treatments in the final life-phase

Zinnige Zorg (Appropriate Care)

Zorginstituut Nederland’s motto is "Taking care of good health care: no more and no less than necessary". Every citizen must be able to count on receiving good health care. No more and no less than is necessary, while also avoiding unnecessary costs.
As a public organisation, the Zorginstituut assesses health care systematically. We assess whether diagnostics and (therapeutic) interventions are being deployed in a patient-oriented, effective and cost-effective manner. We do these analysis within the framework of the 'Zinnige Zorg' (Appropriate Care) programme of Zorginstituut Nederland.

This report is a summary of recommendations by Zorginstituut Nederland. The original text is in Dutch.