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Dutch Healthcare Institute updated the framework for the assessment of the technologies for inclusion in the Basic Health Insurance
According to the Dutch Health Insurance Act, only medical care that is effective and complies with the "state of science and practice" criteria can be reimbursed under the basic health insurance package. Based on the “state of science and practice” criteria, the Dutch Healthcare Institute (ZIN), health insurers, and healthcare providers examine whether care has sufficiently proven effectiveness. The "state of science and practice" criteria are the legal criteria that medical care must meet to be eligible for inclusion in the Basic Health Insurance Package.
On April 11, 2023, the ZIN published the 2023 version of the assessment framework of the "state of science and practice" criteria, including the assessment framework itself, modules with additional explanations for its application, and other information material.
In the update of the assessment framework, the ZIN, among other things, answers questions from society and politics about the future-proofing of the "state of science and practice" criteria due to continuous developments in healthcare. The updated version provides more insight into the flexibility of the assessment framework when dealing with uncertainties about care effectiveness (for example, in innovative care and treatments for rare diseases).
For some treatments or forms of care, further questions may exist about applying the "state of science and practice" assessment framework. To address these questions, ZIN introduced modules with explanations and further elaboration. All modules will belong to the assessment framework and do not form a separate framework. The "state of science and practice" assessment framework remains the leading for all situations. The first module published by ZIN is intended to assess the "state of science and practice" criteria for tumor-agnostic drugs and other oncology drugs studied exclusively in single-arm studies.
The full details in Dutch can be found here.
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