The National Health Care Institute advises the Minister of Health, Welfare and Sport (VWS) to negotiate a lower price with the manufacturers of daratumumab, carfilzomib and isatuximab. These medicinal products are already being reimbursed from the basic health care package. The medicinal products can be used in certain patients with multiple myeloma, which is a cancer in the bone marrow. The reason for this advice was a pilot to assess multiple medicinal products for multiple myeloma at the same time. This was done using a disease model developed by Erasmus University. This pilot started in 2022 and ends with the issuing of this advisory report.
New version budget impact analysis
The National Health Care Institute found that VAT was not consistently taken into account in all calculations in the previously published budget impact analysis (BIA) of 23 December 2024. In the version of 12 February 2025, we corrected this and made it clearer what quantities are inclusive and exclusive of VAT. You can find the BIA on page 75 of the document via this link.
Annex to be requested separately
For academic publication purposes, the health care costs model of the Erasmus School of Health Policy & Management (ESHPM) is not included in the PDF. It will be available later on this site. Interested parties can request the model by sending an e-mail to warcg@zinl.nl.
Current state of affairs: advisory report sent to the Minister
The National Health Care Institute has sent this advice to the Minister of VWS. The pilot period ends with the issuing of this advisory report. This means that from 27 January 2025 onwards the regular assessment procedure will be reinstated for all MM medicinal products. The Minister makes the final decision on whether to negotiate a lower price for daratumumab, carfilzomib, and isatuximab.
Advice from the National Health Care Institute
The disease model shows that MM patients who are not eligible for stem cell transplantation live longer thanks to the use of new medicinal products. However, the model also shows that for most treatment options, the costs of the MM medicinal products are not in an appropriate proportion to the expected health benefits for these patients.
Reason for advice
In 2022, the National Health Care Institute launched a pilot to develop an indication-wide approach for the evaluation of medicinal products for the treatment of multiple myeloma. This pilot included the help of a task group (treating physicians, patients, health care insurers) and a sounding board group (marketing authorisation holders). At the time of the pilot, a temporary route was established for assessing new MM medicinal products.
The pilot was the follow-up to two National Health Care Institute advisory reports about combinations of medicinal products for multiple myeloma. On 11 February 2021, the National Health Care Institute issued an advisory report to the Minister of VWS on 6 treatment combinations for patients with MM. This advisory report concerned combinations of the (lock procedure) medicinal products lenalidomide, daratumumab, carfilzomib and pomalidomide:
On 25 May 2021, we issued an additional advice on the lock procedure medicinal product isatuximab (Sarclisa), which is also used in MM:
The National Health Care Institute stated that the effectiveness of these medicinal products had been sufficiently demonstrated. But because the treatment options for MM change so rapidly, the National Health Care Institute advised the Minister to start a pilot for a new assessment approach for MM medicinal products. The Minister adopted that advice. We also recommended that the MM medicinal products assessed in the pilot period should only be conditionally included in the basic health care package and after rigorous price negotiation.
More information or questions?
If you have any questions about this advice, please send your question to the National Health Care Institute via warcg@zinl.nl. If you have questions about the reimbursement of a medicinal product, the personal expenses or whether you should pay a contribution, please ask your health insurance provider.
How did the advice come about?
The Scientific Advisory Board (WAR) and the Insured Package Advisory Committee (ACP) advise the National Health Care Institute when issuing a package advice. The final decision as to whether or not reimbursement from the basic health care package will take place lies with the Minister.