Mark Nuijten,  PhD, MD, MBA – Adj. Professor Health Economics and Valuation

Mark is medical doctor, health economist,  valuation economist,  and healthcare journalist. He has become a leading health policy and health economics expert over the last two decades, reflected in more than 200 publications and leading positions in scientific societies and editorial boards. Mark was Board Director of ISPOR (2002-2004) and Chair of the Management Board of Value in Health (2002-2004)., and member of the Editorial Advisory Board of Value in Health. He obtained his PhD in health economics (2003) on the thesis “In search for more confidence in health economic modelling” at the Erasmus University, Rotterdam.

He has been for more than a decade academic supervisor of PhD programs at the University of Maastricht (nutrition-economics in malnutrition, nutrition-economics in obesity) and the University of Groningen(reimbursement policies for medical innovation, including stratified medicine) in The Netherlands and founder of the ISPOR Special Interest Group on nutrition-economics. Since 2017 he is Adjunct Professor at ITU (Istanbul Technical University) in Turkey on Health Economics and Valuation, and he has been Visiting Professor in Israel (Tel Aviv) in 2019.

He is a pioneer in the field of healthcare innovation in biotechnology and nutrition, and has been the first classical health economist successfully applying and developing Discounted Cash Flow methodologies for valuation of biotechnology innovation. For example, developing a Pricing Matrix Model for research in early phase development, which is pragmatic precursor  of the later proposed conjoint analysis for multicriteria decision-making in healthcare. Another example is the Financial Valuation Algorithm for the assessment of the future sales of a new, innovative medicinal product. His models successfully contributed to positive reimbursement decisions by health authorities in many countries, (for example, NICE in England, SMC in Scotland, TLV in Sweden, and Zin in The Netherlands).

He also proposed a change in the paradigm in reimbursement decisions on innovative expensive drugs to determine the price of ultra-innovative orphan drugs including the investor’s perspective (2016) He introduced a Pricing Model to assess the break-even price of an innovative drugs from an investor’s perspective in a Nature journal. 

In period from 2005 to 2020, he has established nutritioneconomics as a new discipline by means of series of breakthrough conceptual papers and practical applications. He was initial founder of the ISPOR Special Interest Group on nutrition-economics and he performed over the last 10 years more than 20 projects for the leading nutrition companies (Danone, Nestlé, Abbott, DSM) both for medical nutrition and consumer markets, which have resulted in numerous policy and research papers.

From the beginning, he developed new mathematical concepts for exploring statistical and other uncertainty.

His book “In search for more confidence in health economic modelling”, explores new mathematical concepts for exploring statistical and other uncertainty: e.g. the incorporation of potential confounding variables, inter-variable uncertainty in decision analytic modelling, and incorporation of statistical uncertainty in health economic modelling studies using second-order Monte Carlo simulations. An appealing example is the use of the economic concept of elasticity to assess uncertainty in cost-effectiveness analyses.   Another example,  is a new concept to capture critical issues of a sensitivity analysis, which is based on statistical methods based on Markov chain modelling and regression analysis, using the framework of the Taylor series expansion around a point, are used to derive an equation for 1-way sensitivity analyses. 

He has been leading export in developing budget impact analysis as separate discipline. He published practical issues in handling data input and uncertainty in a budget impact analysis and principles of good practice for budget impact analysis.

Mark is founder of A2M (Ars Accessus Medica) and founding partner of the Minerva International Health Economic Network. Mark was trained as a physician and worked in clinical research before obtaining his international M.B.A. from Erasmus University, Rotterdam, where he later was senior staff member. Prior to setting up Ars Accessus Medica, Mark was a partner with MEDTAP International. As a VP Business Development for Europe he established global Pricing and Reimbursement Consultancy Services for MEDTAP. Before his MEDTAP period, Mark was the founder and first Managing Director of the Quintiles office in the Netherlands, which included European responsibility for the policy and health economic division The Lewin Group.

Academic innovation

In 1996 he was first researcher to apply economic concept of elasticity to assess uncertainty in cost-effectiveness analyses. [i] [ii]

In 1998 he published two papers simultaneously in the March issue of PharmacoEconomics.[iii] [iv]

In 1999 he was member of Advisory Board for the  first Dutch  Pharmaeconomic Research Guidelines.

In 1999 he was with 3 papers most referenced author in the first Dutch Pharmaeconomic Research Guidelines.  [v] [vi] [vii]  [viii]

In 2000 he was member of the Advisory Board for the development of the first Dutch Manual for Costing: Methods and Reference Prices for Economic Evaluations in Healthcare.

In 2003 his assessment of the cost-effectiveness analysis of interferon beta in multiple sclerosis was highest foreign non-English study in ranking by NICE. [ix]

In 2001, two papers by him were simultaneously published in the July-August issue of Value in Health. [x] [xi]

In 2004, he was winner of the Board of Directors Service Award.

In 2004 he introduced the Pricing Matrix Model, which is first assessment of preferences by decision makers for critical clinical and economic attributes of new innovative drugs in reimbursement decision-making process. [xii] [xiii] [xiv] Pricing Matrix Model is pragmatic precursor  of the later proposed conjoint analysis for multicriteria decision-making in healthcare.

In 2003, he published a book “In search for more confidence in health economic modelling”, which explores new mathematical concepts for exploring statistical and other uncertainty: e.g. the incorporation of potential confounding variables, inter-variable uncertainty in decision analytic modelling, and incorporation of statistical uncertainty in health economic modelling studies using second-order Monte Carlo simulations.

He has been leading export in developing budget impact analysis as separate discipline. 2010 he published first practical issues in handling data input and uncertainty in a budget impact analysis.[xv] an he was author of the ISPOR Task Force on good research practices for budget impact analysis in 2007, [xvi] and author of other new concepts for budget impact analysis, combining a budgetary impact analysis and a cost-effectiveness analysis for subpopulations. [xvii] [xviii]

The period from 2007 to 2013 shows nicely his experience with development of multicountry  health economic models, e.g. in post-herpetic neuralgia, renal failure and RSV in children. [xix] [xx] [xxi] [xxii] [xxiii][xxiv] [xxv][xxvi] [xxvii] [xxviii] [xxix] [xxx] [xxxi] [xxxii]The countries included UK, US, Germany, Portugal, Russia, Austria, Netherlands in published papers, but actual number of countries varied between 10 and 16 countries for each indication. These models successfully contributed to positive reimbursement decisions by health authorities in many countries, (for example, NICE in England, SMC in Scotland, TLV in Sweden, and Zin in The Netherlands).

In 2011, Mark Nuijten and Pieter van Gelder introduced a new concept to capture critical issues of a sensitivity analysis. [xxxiii] Statistical methods based on Markov chain modelling and regression analysis, using the framework of the Taylor series expansion around a point, are used to derive an equation for 1-way sensitivity analyses. In particular, equations for costs and effects are being developed,  from which the cost-effectiveness ratio is built. The article shows the feasibility of such equations for the execution of 1-way sensitivity analyses.

In 2011, he writes a widely cited critical essay on the methodological issues in cost-effectiveness analysis which can be in conflict with European social values and medical ethics. [xxxiv]

In 2013 he published a paper about pitfalls in the valuation of pharmaceutical and biotechnology pharmaceutical, which is the first paper in a series of publications about valuation of healthcare innovation. [xxxv] Since 2013 until now, he has been first classical health economist successfully applying and developing Discounted Cash Flow methodologies for early phase valuation of biotechnology innovation using Financial Valuation Algorithm for the assessment of the future sales of a new, innovative medicinal product in 2014. [xxxvi]  [xxxvii][xxxviii]

Since 216, he also proposed a change in the paradigm in reimbursement decisions on innovative expensive drugs to determine the price of ultra-innovative orphan drugs including the investor’s perspective. [xxxix][xl]  He introduced a Pricing Model to assess the break-even price of an innovative drugs from an investor’s perspective. This model applies concepts from economic valuation theory, which is based on the expected free cash flows and the required return on investment. In 2018, he published critical comments on another proposal for a cancer drug pricing model in a Nature journal. [xli]

In period from 2005 to 2020, he has established nutritioneconomics as a new discipline by means of series of breakthrough conceptual papers and practical applications. He was initial founder of the ISPOR Special Interest Group on nutrition-economics and he performed over the last 10 years more than 20 projects for the leading nutrition companies (Danone, Nestlé, Abbott, DSM) both for medical nutrition and consumer markets, which have resulted in numerous policy and research papers [xlii] [xliii] [xliv] [xlv] [xlvi]  [xlvii][xlviii] [xlix] [l] and chapters in two books. [li][lii]

In 2020, in his paper “Are cost-effectiveness data in nutrition a double edged sword for nutrition companies” he takes a strategic business perspective for nutrition companies. [liii]

References

[i] Nuijten MJC.  Hardens M. Measuring sensitivity in pharmacoeconomics studies:  An integration of point-sensitivity and range-sensitivity”.  PharmacoEconomics, November 1997; 12 (5): 555-564.

[ii] Nuijten, MJC. Hardens M. Measuring sensitivity in pharmacoeconomic studies: an integration of point-sensitivity and range-sensitivity: a refinement by incorporation of probability distributions.  PharmacoEconomics, 1999; 16 (1): 33-41.

[iii] Nuijten MJC. The selection of data sources for use in modelling studies. PharmacoEconomics, March 1998; 3 (3): 305-316.

[iv] Nuijten MJC, Starzewski J.  Applications of Modeling Studies.  PharmacoEconomics, March 1998; 3 (3): 289-291.

[v] National Health Insurance Council. Report on Pharmacoeconomic Research Guidelines. Amstelveen, The Netherlands: National Health Insurance Council, 1999.

[vi] Nuijten MJC, Pronk MH, Brorens MJ, Hekster YA, Lockefeer JH, de Smet PA, Bonsel G, van der Kuy A. Reporting format for economic evaluation. Part I: Application to the Dutch healthcare system. PharmacoEconomics, August; 14 (2): 1998; 159-163.

[vii] Nuijten MJC, Pronk MH, Brorens MJ, Hekster YA, Lockefeer JH, de Smet PA, Bonsel G, van der Kuy A. Reporting format for economic evaluation. Part II: Focus on modelling studies. Pharmacoeconomics. 1998 Sep;14(3):259-68. 

[viii] Nuijten MJC. The selection of data sources for use in modelling studies. PharmacoEconomics, March 1998; 3 (3): 305-316.

[ix] Nuijten MJC, Hutton J. Cost-effectiveness analysis of interferon beta in multiple sclerosis: a Markov process analysis. Value Health. 2002 Jan-Feb;5(1):44-54.

[x] Nuijten MJC, van Iperen P, Palmer C, van Hilten BJ, Snyder E.  Cost-effectiveness analysis of entacapone in Parkinson's disease: a Markov process analysis. Value Health. 2001 Jul-Aug;4(4):316-28.

[xi] Nuijten MJC. Assessment of clinical guidelines for continuation treatment in major depression. Value Health. 2001 Jul-Aug;4(4):281-94.

[xii] Nuijten MJC, Kosa J Pricing of Pharmaceuticals. Assessing the Pricing Potential by a Pricing Matrix Model. Eur J Health Econom 2004; 5:110-115.  

[xiii] Nuijten MJ. Pricing matrix model: dealing with uncertainty. Eur J Health Econ. 2007 Dec;8(4):333-7. Epub 2007 Jan 13. 

[xiv] Nuijten MJC. The Application of Free Market Theory to the Health Care Market. Eurohealth Winter. 2003/2004; 9(4):13-17.

[xv] Nuijten MJ, Mittendorf T, Persson U. Practical issues in handling data input and uncertainty in a budget impact analysis. Eur J Health Econ 2010;  (DOI: 10.1007/s10198-010-0236-4.

[xvi] Principles of good practice for budget impact analysis: report of the ISPOR Task Force on good research practices--budget impact analysis.Value Health. 2007 Sep-Oct;10(5):336-47

[xvii] Nuijten MJC and Rutten F. Combining a Budgetary Impact Analysis and a Cost-Effectiveness Analysis Using Decision Analytic Modelling Techniques. PharmacoEconomics 2002;20(12):855-67.

[xviii] Nuijten MJC, Kosa J, Engelfriet P. Modeling the Cost-Effectiveness and Budgetary Impact for Subpopulations. European Journal of Health Economics 2003; 4:70-78. 

[xix] Dakin H, Nuijten M, Liedgens H, Nautrup BP. Cost-effectiveness of a lidocaine 5% medicated plaster relative to gabapentin for postherpetic neuralgia in the United Kingdom. Clin Ther. 2007 Jul;29(7):1491-507

[xx] Liedgens H, Hertel N, Gabriel A, Nuijten M, Dakin H, Mitchell S, Nautrup BP. Cost-effectiveness analysis of a lidocaine 5% medicated plaster compared with gabapentin and pregabalin for treating postherpetic neuralgia: a German perspective. Clin Drug Investig. 2008;28(9):583-601.

[xxi] Ritchie M, Liedgens H, Nuijten M. Cost effectiveness of a lidocaine 5% medicated plaster compared with pregabalin for the treatment of postherpetic neuralgia in the UK: a Markov model analysis. Clin Drug Investig 2010; 30 (2): 71-87.

[xxii] Liedgens H, Obradovic M, Nuijten M. Health economic evidence of 5% lidocaine medicated plaster in post-herpetic neuralgia. Clinicoecon Outcomes Res. 2013 Nov 25;5:597-609.

[xxiii] Nuijten M, Andress DL, Marx SE, Sterz R. Chronic kidney disease Markov model comparing paricalcitol to calcitriol for secondary hyperparathyroidism: a US perspective. Curr Med Res Opin 2009; 25 (5): 1221-34

[xxiv] Nuijten M, Andress DL, Marx SE, Curry AS, Sterz R. Cost Effectiveness of Paricalcitol versus a non-selective vitamin D receptor activator for secondary hyperparathyroidism in the UK: a chronic kidney disease markov model. Clin Drug Investig 2010; 30 (8): 545-57.

[xxv] Macedo A, Andrade S, Mulchande M, Marx SE, Nuijten M. Estudo de Avaliação do Custo-Efectividade da Utilização de Paricalcitol. no Tratamento de Doentes com Insuficiência Renal Terminal e Hiperparatiroidismo Secundário em Portugal Rev Port Farmacoter. 2011;3:75-86.

[xxvi] M. Nuijten, A. Rudakova, T. Marshall. Health economic evaluation of paricalcitol and combination of cinacalcet  with non-selective vitamin D in patients with chronic kidney disease in Russian Federation. 2014. ISSN 1561_6274 .616.61-036.92-08.857-0612(471)

[xxvii] Nuijten MJ, Wittenberg W, Lebmeier M. Cost effectiveness of palivizumab for respiratory syncytial virus prophylaxis in high-risk children: a UK analysis. Pharmacoeconomics. 2007;25(1):55-71.

[xxviii] Resch B; Gusenleitner W; Nuijten M.J C; Lebmeier M.; Wittenberg W.. Cost-effectiveness of palivizumab against respiratory syncytial viral infection in high-risk children in Austria. Clinical therapeutics 2008;30(4):749-60

[xxix] Nuijten M, Lebmeier M, Wittenberg W. Cost effectiveness of palivizumab for RSV prevention in high-risk children in the Netherlands. J Med Econ 2009; 12 (4): 291-300.

[xxx] Nuijten M, Lebmeier M, Wittenberg W. Cost effectiveness of palivizumab in children with congenital heart disease in Germany. J Med Econ 2009; 12 (4): 301-8.

[xxxi] Nuijten MJ, Wittenberg W. Cost effectiveness of palivizumab in Spain: an analysis using observational data. Eur J Health Econ 2010; 11 (1): 105-15.

[xxxii] Resch B, Sommer C, Nuijten MJ, Seidinger S, Walter E, Schoellbauer V, Mueller WD. Cost-effectiveness of Palivizumab for Respiratory Syncytial Virus Infection in High-risk Children, Based on Long-term Epidemiologic Data From Austria. Pediatr Infect Dis J 2011; PMID: 21960187

[xxxiii] Nuijten MJ, Van Gelder PH. Concise Equation That Captures the Essential Elements of One-Way Sensitivity Analyses in Health Economic Models. Med Decis Making 2011;  (): PMID: 21252378.

[xxxiv] Nuijten MJ, Dubois DJ. Cost-utility analysis: current methodological issues and future perspectives. Front Pharmacol 2011; 2 (): 29. PMID: 21713127.

[xxxv] Mark Nuijten. Pitfalls in the Valuation of a Pharmaceutical Company. Journal of Private Equity. Fall 2013, Vol. 16, No. 4: pp. 57–66.

[xxxvi] Mark Nuijten and Marja Pronk. Financial Valuation Algorithm for the Assessment
of the Future Sales of a New, Innovative Medicinal Product. The Journal of Private Equity. Summer 2014, Vol. 17, No. 3: pp. 35-44. DOI: 10.3905/jpe.

[xxxvii] Mark Nuijten. The Potential Impact of Current and Future Pharmaceutical Policy Changes on Cash Flows for Innovative Medicines. The Journal of Private Equity Vol. 18, No. 1 (WINTER 2014), pp. 34-45.

[xxxviii] Fugel HJ, Nuijten M, Postma M. Economic viability of Stratified Medicine concepts: An investor perspective on drivers and conditions that favour using Stratified Medicine approaches in a cost-contained healthcare environment. N Biotechnol. 2016 Dec 25;33(6):860-867. doi: 10.1016/j.nbt.2016.09.003. Epub 2016 Sep 21.

[xxxix] Nuijten MJC, Vis J. Evaluation and valuation of innovative medicinal products.  J Rare Dis Res Treat. (2016) 2(1): 1-11.

[xl] Nuijten M, Fugel HJ, Vis J. Evaluation and Valuation of the Price of Expensive Medicinal Products: Application of the Discounted Cash Flow to Orphan Drugs. J Rare Dis Disord 2018, 1:005. Volume 1 | Issue 1.

[xli] Nuijten M, Vis J. Economic comments on proposal for a novel cancer drug pricing model. Nature Rev Clin Oncol. 2018 Sep;15(9):587. doi: 10.1038/s41571-018-0083-2.

[xlii] Nuijten M, Lenoir-Wijnkoop I. Nutrition economics: An innovative approach to informed public health management. Eur J Pharmacol 2011;  PMID: 21810421.

[xliii] Lenoir-Wijnkoop I, Dapoigny M, Dubois D, van Ganse E, Gutiérrez-Ibarluzea I, Hutton J, Jones P, Mittendorf T, Poley MJ, Salminen S, Nuijten MJ. Nutrition economics - characterising the economic and health impact of nutrition. Br J Nutr 2010.

[xliv] Lenoir-Wijnkoop I, Nuijten MJ, Gutiérrez-Ibarluzea I, Hutton J, Poley MJ, Segal L, Bresson JL, van Ganse E, Jones P, Moreno L, Salminen S, Dubois D. Workshop Report: concepts and methods in the economics of nutrition--gateways to better economic evaluation of nutrition interventions. Br J Nutr. 2012 Nov 14;108(9):1714-20. doi: 10.1017/S0007114512003704.

[xlv] Lenoir-Wijnkoop I, van Aalderen WM, Boehm G, Klaassen D, Sprikkelman AB, Nuijten MJ. Cost-effectiveness model for a specific mixture of prebiotics in The Netherlands. Eur J Health Econ 2010;  (): .PMID: 21165666.

[xlvi] Lenoir-Wijnkoop I, Nuijten MJ, Craig J, Butler CC. Nutrition economic evaluation of a probiotic in the prevention of antibiotic-associated diarrhea. Front Pharmacol. 2014 Feb 17;5:13.

[xlvii] Lotan Y, Buendia Jiménez I, Lenoir-Wijnkoop I, Daudon M, Molinier L, Tack I, Nuijten MJ. Primary prevention of nephrolithiasis is cost-effective for a national healthcare system. BJU Int. 2012 Dec;110(11 Pt C):E1060-7.

[xlviii] Freijer K, Tan SS, Koopmanschap MA, Meijers JM, Halfens RJ, Nuijten MJ. The economic costs of disease related malnutrition. Clin Nutr. 2013 Feb;32(1):136-41. doi: 10.1016/j.clnu.2012.06.009.

[xlix] Naberhuis JK, Bell JD, Goates S, Nuijten M. Global Publication Trends in Medical Nutrition Health Economics. Value Health. 2015 Nov;18(7):A553. doi: 10.1016/j.jval.2015.09.1780. Epub 2015 Oct 20.

[l] Jane K Naberhuis, Vivienne N Hunt, Jvawnna D Bell, Jamie S Partridge, Scott Goates, Mark JC Nuijten.  Health care costs matter: a review of nutrition economics – is there a role for nutritional support to reduce the cost of medical health care? August 2917. DOI. Vol. 2017.9: 55-62. DOI. https://doi.org/10.2147/NDS.S126232

[li] Nuijten M. Health Economics in Medical Nutrition: An Emerging Science. Nestle Nutr Inst Workshop Ser. 2015;82:129-41. doi: 10.1159/000382009. Epub 2015 Oct 20. PMID: 26545115.

[lii] Nuijten M. Vitamin E and Healthcare Costs: Models to Assess the Impact. Part V: Public Health Implications of Vitamin E. Vitamin E in Human Health.  Book: Nutrition and Health. Editors: P. Weber, M. Birringer, J. Blumberg. M. Eggersdorf. J. Frank. Humana Press. 2019. ISBN 978-3-030-05314-7.

[liii] Nuijten M. Nutrition economics: Are cost-effectiveness data in nutrition a double edged sword for nutrition companies? Integrative Food, Nutrition and Metabolism. Vol7: 1-6. doi: 10.15761/IFNM.1000280.

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