Up for high-hanging fruit – Evaluation of the Dutch expensive medicines policy 2016-2018
The Ministry of Health, Welfare and Sport asked consultancy firms SiRM – Strategies in Regulated Markets – and Common Eye to conduct an ex durante (interim) evaluation of its medicines policy, as part of the pilot programme called ‘Learning through evaluation’. ‘Learning through evaluation’ is a new approach to policy evaluation. It focuses both on critical examination of the effects of the policy, as well as on drawing lessons from the design and implementation of the policy. The Dutch medicines policy was sent to the Dutch House of Representatives early 2016, by Minister of Health, Welfare and Sport, Edith Schippers. Its central purpose is to safeguard access to innovative medicines at socially acceptable costs.
In the context of the evaluation, SiRM and Common Eye were asked to study the effects of the Dutch medicines policy, to describe how its effectiveness could be improved, and to identify indicators to monitor policy effectiveness and efficiency in preparation of the ex post evaluation in 2022. In addition, the ministry asked the consultancy firms to report benefits of the new evaluation approach.
We conclude that during the first three years after publication of the Dutch medicines policy, the low-hanging fruit has been picked. Now, halfway through the predetermined policy period, the time has come for high-hanging fruit and the use of additional indicators to monitor policy effects in preparation of the ex post evaluation.
Low-hanging fruit has been picked
Based on interviews, questionnaires, interactive sessions and desk research, we conclude that the low-hanging fruit has been picked during the first three years of the predetermined policy period of the Dutch medicines policy. Its publication has resulted in a sense of urgency in the healthcare field, originating from a joint responsibility to control innovative medicines expenditures. In addition, its implementation contributed towards its goals in several ways. First, prices have been reduced to a certain extent. However, they remain high. Second, appropriate use of innovative medicines has become an important theme, but is not yet systematically investigated and implemented for each innovative medicine that enters the market. Third, all innovative medicines have been included in the healthcare insurance package. However, there remains relatively little insight into timely access to innovative medicines across Dutch hospitals.
Halfway through, the time has come for high-hanging fruit
Halfway through the predetermined policy period, the time has come to reach for high-hanging fruit. The Ministry of Health, Welfare and Sport is already active in this regard. Yet, we recommend the ministry to apply more focus on the effective deployment of people and resources, both in government as well as in the healthcare sector. At a national level, we recommend to focus on optimisation of the current procurement of innovative medicines and on stimulating and facilitating research on appropriate use of innovative medicines. At the European level, we recommend to focus on the realisation of socially acceptable prices for innovative medicines, by exerting joint pressure on prices and by refining European / global laws and regulations.
The ex post evaluation requires additional indicators
The ex post evaluation of the medicines policy in 2022 requires additional indicators. We recommend evaluating the policy’s effectiveness by measuring affordability and accessibility of innovative medicines. We propose 16 novel indicators to measure policy effectiveness: 12 for the affordability of innovative medicines and four for their accessibility. Only a few measures allow for the measurement of efficiency of the medicines policy, such as the measure to negotiate prices of innovative medicines at a national level. The use of proposed indicators for effectiveness and efficiency requires additional data.
Process Gain: Interim policy adjustment offers opportunities, its integration creates challenges
Ex durante (interim) evaluation is a new way of policy evaluation that offers opportunities, but its integration creates challenges. Ex durante evaluation provides opportunities for reflection and policy adjustment, unlike conventional ways of (ex post) policy evaluation. However, the current approach to the interim evaluation seems suboptimal: it proved to be difficult to make time for the evaluation and topics covered by the medicines policy were too broad for a single evaluation. In addition, it was difficult to facilitate a safe and productive learning environment, as results of the evaluation were to be made public. We expect that an internal, continuous process of interim evaluations linked to monitoring of the proposed indicators, will be more successful.