{"entity":{"id":"zorginstituut-nederland","kind":"institution","name":"Zorginstituut Nederland (National Health Care Institute)","aka":["Zorginstituut","ZIN","Zorginstituut Nederland","National Health Care Institute","Dutch National Health Care Institute"],"tldr":"The Dutch government body that advises the health minister on what the compulsory basic health insurance covers, including whether each expensive new cancer drug is worth its price.","summary":"Everyone who lives or works in the Netherlands must hold a health insurance policy, and every policy covers the same basic package (basispakket). The Zorginstituut describes its most important task as making sure that the basic package reimburses only treatments established to work and to suit what the patient needs; it advises the health minister, who takes the final decision on what the package contains. It judges care against four package criteria: necessity, effectiveness, cost-effectiveness and feasibility, with advice from two independent committees, the Scientific Advisory Board (WAR), which tests the evidence against the 'state of science and practice', and the Package Advisory Committee (ACP), which weighs the interests of the patients concerned against those of other patients and of all premium payers.\n\nIts 2024 framework for cost-effectiveness sets three reference values for the maximum extra cost per quality-adjusted life year, depending on how severe the disease is, measured by proportional shortfall: up to €20,000 for a burden of 0.10 to 0.40, up to €50,000 for 0.41 to 0.70, and up to €80,000 for 0.71 to 1.00. The framework calls the reference value a ceiling, not a target. New hospital medicines expected to cost €20 million or more a year across their indications, or €10 million a year for one indication at €50,000 or more per patient, can be held out of the package in the 'sluis' (lock) until the Zorginstituut has advised and the ministry has negotiated the price; the minister takes the final decision. In 2026 it advised that durvalumab for extensive small-cell lung cancer could be reimbursed only after a price cut of at least 60 per cent, which followed on 29 August 2026 after an agreement with the supplier, and that trastuzumab deruxtecan for HER2-mutant lung cancer needed a cut of at least 53 per cent.\n\nIt can also admit promising care conditionally while evidence is gathered: TIL therapy for melanoma was admitted that way from 2015 to 2022, judged effective and reimbursed from 15 January 2023, and dropped from the package on 15 January 2026 when no new hospital exemption was granted.","asOf":"2026-11-03","links":[{"label":"Official website (Dutch)","url":"https://www.zorginstituutnederland.nl"},{"label":"Compulsory deductible, with the Zorginstituut's description of its task (Dutch)","url":"https://www.zorginstituutnederland.nl/verzekerde-zorg/e/eigen-risico-zvw"},{"label":"The lock for expensive medicines (Dutch)","url":"https://www.zorginstituutnederland.nl/wat-wij-doen/programmas-en-samenwerkingsverbanden/horizonscan-geneesmiddelen/sluis-voor-dure-geneesmiddelen"},{"label":"Framework for cost-effectiveness, 26 November 2024 (Dutch, PDF)","url":"https://www.zorginstituutnederland.nl/site/binaries/site-content/collections/documents/2024/11/26/beoordelingskader-kosteneffectiviteit-van-zorg/Beoordelingskader+kosteneffectiviteit+van+zorg.pdf"},{"label":"Medicines currently in the lock (Dutch)","url":"https://www.zorginstituutnederland.nl/wat-wij-doen/programmas-en-samenwerkingsverbanden/horizonscan-geneesmiddelen/sluis-voor-dure-geneesmiddelen/overzicht-geneesmiddelen-in-de-sluis"},{"label":"Position on TIL therapy and its lapse in 2026 (Dutch)","url":"https://www.zorginstituutnederland.nl/documenten/2022/12/13/standpunt-tumorinfiltrerende-lymfocyten-til"}],"tags":[],"related":["cbg-meb","iknl","ema"],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["tacquell"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"city":"Diemen","country":"NL","lat":52.3297,"lng":4.9596,"institutionType":"government","website":"https://www.zorginstituutnederland.nl","programs":["Basic package advice (pakketadvies)","Expensive medicines lock (sluis)","Horizon scan of medicines","Conditional admission (voorwaardelijke toelating)","GIP medicines use database"]},"route":"/institutions/zorginstituut-nederland/","neighbours":{"institution":[{"id":"ema","kind":"institution","name":"European Medicines Agency","route":"/institutions/ema/"},{"id":"cbg-meb","kind":"institution","name":"Medicines Evaluation Board (CBG-MEB)","route":"/institutions/cbg-meb/"},{"id":"iknl","kind":"institution","name":"Netherlands Comprehensive Cancer Organisation (IKNL)","route":"/institutions/iknl/"}],"drug":[{"id":"tacquell","kind":"drug","name":"Tacquell (autologous melanoma-derived tumour-infiltrating lymphocytes)","route":"/drugs/tacquell/"}]}}