Scheijmans Féline E V, van der Wal Roosmarijn, Zomers Margot L, van Delden Johannes J M, van der Pol W Ludo, van Thiel Ghislaine J M W
Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Public Health, Healthcare Innovation & Evaluation and Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
PLoS One. 2025 Jan 8;20(1):e0317188. doi: 10.1371/journal.pone.0317188. eCollection 2025.
Solidarity-based healthcare systems are being challenged by the incremental costs of new and expensive medicines for cancer and rare diseases. To regulate reimbursement of such drugs, the Dutch government introduced a policy instrument known as the Coverage Lock (CL) in 2015. Little is known about the public opinion regarding such policy instruments and their consequences, i.e., reimbursement of some, but not all, expensive medicines. We aimed to identify the preferences of Dutch citizens regarding the reimbursement of expensive medicines, and to investigate the views of the public on the use of the CL as a healthcare policy instrument and their input for improvement.
Web-based survey of a representative sample of 1999 Dutch citizens aged 18 years and older (panel of research company Kantar Public). Potential respondents were approached via e-mail. Several policy measures, real-life cases and statements related to the CL were presented in the survey to respondents. Their responses were analysed by tabulating descriptive statistics (proportions and percentages).
1179 individuals (response rate 59%) filled in the questionnaire. Although a majority considered the CL policy unjustified, they preferred it to the alternative policy measures that were presented. In four real-life case descriptions of patients in need of expensive medicines, respondents most often indicated effectiveness, lack of availability of alternative treatment and improved quality of life due to treatment as reasons for a positive reimbursement decision. An unfavourable cost-benefit ratio was their main reason to be against reimbursement. Some argued that withholding reimbursement was a way of informing manufacturers that extremely high prices are unacceptable.
There is public support for patients in need of expensive medicine. Many respondents supported the CL as a reimbursement policy. However, there is a wish to optimize the interpretation of the assessment criteria and the weight these are attributed in decision making about reimbursement of expensive innovative medicine for patients.
基于团结的医疗体系正面临癌症和罕见病新型昂贵药物成本不断增加的挑战。为规范此类药物的报销，荷兰政府于2015年引入了一种名为“覆盖锁定”（CL）的政策工具。对于此类政策工具及其后果，即部分而非全部昂贵药物的报销情况，公众看法知之甚少。我们旨在确定荷兰公民对昂贵药物报销的偏好，并调查公众对将CL用作医疗政策工具的看法及其对改进的意见。
对1999名18岁及以上荷兰公民的代表性样本进行网络调查（调研公司凯度公共事务的样本小组）。通过电子邮件联系潜在受访者。调查中向受访者展示了与CL相关的多项政策措施、实际案例和陈述。通过列表描述性统计（比例和百分比）分析他们的回答。
1179人（回复率59%）填写了问卷。尽管大多数人认为CL政策不合理，但与所提出的替代政策措施相比，他们更喜欢CL政策。在四个需要昂贵药物的患者的实际案例描述中，受访者最常指出有效性、缺乏替代治疗以及治疗带来的生活质量改善是做出积极报销决定的原因。成本效益比不利是他们反对报销的主要原因。一些人认为拒绝报销是一种告知制造商极高价格不可接受的方式。
公众支持有需要的患者使用昂贵药物。许多受访者支持将CL作为报销政策。然而，人们希望优化评估标准的解释以及这些标准在为患者报销昂贵创新药物决策中所赋予的权重。
