Do Profit Margins of Pharmaceuticals Influence Reimbursement Decisions? A Discrete Choice Experiment Among Dutch Healthcare Decision Makers

Joost J. Enzing*, Sebastian Himmler, Saskia Knies, Werner B.F. Brouwer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
39 Downloads (Pure)


Objectives: This study aimed to investigate whether the profit margins of pharmaceuticals would influence the outcome of reimbursement decisions within the Dutch policy context. Methods: We conducted a discrete choice experiment among 58 Dutch decision makers. In 20 choice sets, we asked respondents to indicate which of 2 pharmaceutical treatment options they would select for reimbursement. Options were described using 5 attributes (disease severity, incremental costs per quality-adjusted life-year, health gain, budget impact, and profit margin) with 3 levels each. Additionally, cognitive debriefing questions were presented, and for validation debriefing, interviews were conducted. Choice data were analyzed using mixed logit models, also to calculate marginal effects and choice probabilities. Results: Results indicated that the specified levels of profit margins significantly influenced choices made. Decision makers were less likely to reimburse a product with a higher profit margin. The relative importance of profit margins was lower than that of the included traditional health technology assessment criteria, but not negligible. When asked directly, 61% of respondents indicated that profit margin should play a role in reimbursement decision making, although concerns about feasibility and the connection to price negotiations were voiced. Conclusions: Our results suggest that if available to decision makers the profit margin of pharmaceutical products would influence reimbursement decisions within the Dutch policy context. Higher profit margins would reduce the likelihood of reimbursement. Whether adding profit margin as an additional, explicit criterion to the health technology assessment decision framework would be feasible and desirable is open to further exploration.

Original languageEnglish
Pages (from-to)222-229
Number of pages8
JournalValue in Health
Issue number2
Publication statusPublished - Feb 2022

Bibliographical note

Funding Information:
The authors thank discussants at the Erasmus Choice Modelling Centre seminar (November 26, 2020) for their helpful methodological advice related to our study. Ethical Approval: Ethical approval for this study was obtained from the Research Ethics Review Committee of the Erasmus School of Health Policy & Management.

Publisher Copyright:
© 2021 ISPOR–The International Society for Pharmacoeconomics and Outcomes Research, Inc


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