The role of medical need in drug reimbursement decision-making

This project studies the concept of medical need in reimbursement decision-making. Previous Escher research has revealed that considerations beyond therapeutic value and cost-effectiveness are increasingly important in decision-making regarding reimbursement. One such consideration is disease severity. However, the way disease severity is measured is often not transparent and differs across countries.

Therefore, this project investigates the role of the concept of disease severity and its operationalisation in reimbursement decision-making in detail in four European countries: the Netherlands, Belgium, France, and Sweden. The project analyzes policy documents and public reimbursement dossiers, and conducts interviews with policymakers involved in reimbursement. Insight into the role of disease severity, as an expression of medical needs in policymaking, can help health care systems evaluate how best to incorporate the concept in their reimbursement systems.