[Economic feasibility study and reimbursement rules--illustrated by a concrete example]

In deciding whether a pharmaceutical drug should be granted reimbursement, economic considerations play a considerable role. However, the fact that the very decision on reimbursement - whether individual, conditional or general--influences the cost-effectiveness of the drug considered as a medical intervention is often overlooked.

In the computation of cost-effectiveness not only purely medical effects should be taken into consideration but also the risk that a patient in need of treatment is not treated--possibly as a consequence of the procedure involved in applying for individual reimbursement--as well as the risk of wasting resources on treatment that is not medically justified. The method is illustrated by a concrete example based on the data from treatment of coronary heart disease patients with statins in the period 1994-1998 where reimbursement was given on an individual basis and after 1998 when conditional reimbursement was introduced.

The individually-based regime turns out to have been very cost-ineffective, given that it prevented medically appropriate treatment of a large number of patients. A simple calculation along the principles outlined here would have shown this resource-loss.

Including the reimbursement regime in the assessment of cost-effectiveness seems to be a useful tool for preventing the loss of patients who could have been treated at a lower cost with the medical intervention considered than with other interventions currently used in the health care sector.