The Netherlands is failing to offer several vaccines that are both medically sound and cost-effective. They are not part of the national vaccination programme (RVP) for children, but they do not satisfy the Medicines Reimbursement System (GVS) that regulates the availability of drugs via GPs and pharmacists either. This claim has been made by Maarten Postma, Professor of Pharmaco-economics at the University of Groningen.
Postma was recently in The Hague to address spokespersons from the Dutch House of Representatives about vaccines that currently fall between two stools. A symposium on the subject will be held at the UMCG on Friday 29 May, as part of the PhD ceremony for two members of Postma’s research group. A representative of the World Health Organization (WHO) will also speak at the symposium.
Postma cites two concrete examples. The HPV vaccine (to protect girls from the human papillomavirus, which can cause cervical cancer) is currently only available (free of charge) via the national vaccination programme to girls of 12 years old. ‘Research has shown that it would be cost-effective to offer the vaccine to teenagers and women up to 24 years of age’, explains Postma. But these women are not part of the national vaccination programme.
Cost-effectiveness is based on the price of a vaccination programme compared with the potential savings resulting from preventing the disease (in this case cervical cancer). The gain in terms of life years is calculated, with a correction for good quality of life. The final result is an estimate of the costs per extra year of good health, known as ‘QALY’ (quality adjusted life years).
Offering HPV vaccinations to girls of 16 years of age would cost less than € 20,000 per QALY. The sum for women up to 24 years of age is less than € 50,000 and can go below € 20,000. Anything less than € 50,000 per QALY is usually deemed cost-effective. And yet the Ministry of Health, Welfare and Sport and the Medicines Reimbursement System review committee has refused to reimburse the HPV vaccination for this group of older girls and younger women. Postma: ‘This is partly because the criteria used were devised for medicines, not vaccines.’
A similar situation applies to the vaccine against the rotavirus, a virus that can cause high temperatures in infants. The infection is rarely fatal, but it can lead to lengthy admissions to hospital. Vaccinating babies would cost around € 3,000 per QALY. ‘But as the national vaccination programme focuses on preventing death and fatalities from the rotavirus are rare, the vaccine does not satisfy the criteria’, says Postma.
By failing to reimburse cost-effective vaccines, the Netherlands is losing out on health profits when compared with neighbouring countries. ‘Effective vaccines are mainly rejected because they do not fit in with the national vaccination programme or the Medicines Reimbursement System. We need a more comprehensive assessment framework that takes account of the total health benefits of vaccines and the cost-effectiveness they generate’, continues Postma. The Health Council of the Netherlands is currently working on a new assessment framework of this kind.
Postma’s research group is the only group in the Netherlands to focus exclusively on the cost-effectiveness of medicines, particularly vaccines. The two PhDs being conferred on Friday relate to an analysis of the cost-effectiveness of vaccinating babies against the rotavirus in Belgium and several other countries, and the use of new economic perspectives for calculating cost-effectiveness.
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