Page 95 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
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The marginal benefits of healthcare spending in the Netherlands
Lastly, other relevant factors need to be taken into account when using thresholds for evaluation of new technologies. Firstly, in our research QALYs do not include differential preferences regarding burden of disease. It could be that a QALY gain for a patient with high disease burden is valued differently than a QALY gain of any other patient. This would still require policy discretion (Harris, 2016). In addition, for technologies with a non-marginal budget impact the thresholds may underestimate the true opportunity costs (Lomas et al., 2018; Paulden, 2016).
 To conclude, we set out to use a new and extensive method to calculate the marginal benefits of spending. Application to Dutch hospital data produced a marginal value of €73,600 per QALY, close to the Dutch upper policy reference value of €80,000 per QALY for new technologies. The research shows that although uncertainty remains, the methodology produces policy makers with informative decision input for resource allocation and new technology assessment. Therefore, it would be valuable to extend, improve and compare the results over more years and different settings.
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