Examining the role of patients’ socioeconomic status in the appraisal stage of health technology assessment in the Netherlands

INTRODUCTION: Socioeconomic health inequalities remain a persistent public health concern, and there is growing recognition of the potential role of health technology assessment (HTA) in addressing them. In the Netherlands, the National Health Care Institute (ZIN) does not formally consider socioeconomic status (SES) in the assessment stage of HTA. This study examined whether SES is considered in the appraisal stage. METHODS: We reviewed all publicly accessible meeting minutes of the appraisal committee published between 2013 and 2024. Minutes were screened for SES-related search terms, and contextual information was extracted on how SES was discussed. For minutes with more extensive SES-related discussions, it was examined whether SES considerations were reflected in final recommendations. RESULTS: SES-related terms were identified in 18 of the 86 meeting minutes. Most references were brief and not followed by further discussion. More extensive discussion occurred in the context of four topics that were discussed in several meetings. Three of these topics concerned reimbursement decisions involving potential additional patient costs. The fourth concerned the updated assessment framework 'Necessity of insurance', in which health inequalities were included as a consideration. Across these four topics, SES was discussed in relation to financial vulnerability, affordability, and access to care for groups with limited resources. CONCLUSIONS: SES does not appear to be systematically considered in the appraisal stage of the HTA process at ZIN. Further research on deliberation and decision making is needed to assess whether and how SES should be incorporated into the decision-making framework and to explore methods allowing integrating SES-related considerations in both assessment and appraisal stages.