Package advice multiple myeloma

Several combination therapies that are used to treat multiple myelomain are placed in the lock procedure for expensive medicinal products, due to the expected disproportionately high cost of use. Zorginstituut Nederland has completed its assessment whether of not these medicinal products (in combination therapy) should be included in the health care package. 

Medicinal products (in combination therapy) for the treatment of multiple myeloma

Multiple myeloma (MM) is a malignant disease of the bone marrow with an unknown cause. It is estimated that approximately 1100 patients, mostly aged 65 years or older, are diagnosed annually in the Netherlands. The medicinal products from the combination therapies mentioned in the report are all currently used in other combinations and/or treatment lines for multiple myeloma. The development of new treatment combinations is rapid. 

Criteria for including treatments in the insured package

The Zorginstituut assessed the combination treatment based on the four package criteria effectiveness, cost-effectiveness, necessity and feasibility. Assessing from the perspective of the basic package which is paid from collective premiums, the Zorginstituut looks at whether new care is better than what is currently available. In doing this we look not only at the degree of certainty that has been achieved, from a scientific perspective and from the perspective of societal support, but also at efficiency aspects. The Zorginstituut was advised by two independent committees: the Scientific Advisory Board (WAR) which examines data on established medical science and medical practice and determines the cost-effectiveness, and the Insured Package Advisory Committee (ACP) which considers the societal assessment. Stakeholders are also consulted during the process.

Preliminary advice

Considering all facts mentioned in the report and based on the special nature of the multiple myeloma indication, the Zorginstituut advises the Minister, in the context of a pilot, to temporarily include the combination therapies mentioned in the report, in the health care package under conditions and following keen price negotiations, pending a definitive approach and advice from the Zorginstituut. It is in the interest of patients with multiple myeloma that the combination therapies that have been mentioned become available. The Zorginstituut will set up a Multiple Myeloma task force, in which the stakeholders are represented. In this task force, we will work together to develop an alternative approach to our advisory process on the use of medicinal products for multiple myeloma. Real-time monitoring and appropriate use research will be given an important focus.

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