104 Chapter 3 commercialized reports and a study by Health Canada that addresses Ig supply and demand for Canada.8 Therefore, the aim of this study is to gain insights into the current and future demand of Ig based on medical need for the Dutch setting. We did this by creating the following research questions: 1. Which clinical specialties contribute to the current demand for Ig? 2. What are potential new areas of medical need that could be explored? 3. What are key transformational factors (from social, technological/ clinical, economical, ecological, political, and legal) that would impact Ig demand and to what effect? 3.2 MATERIALS AND METHODS Setting In the Netherlands, Ig is distributed in two main ways with a separate reimbursement scheme for each: (1) Intramurally (within hospitals), where Ig for approved indications is reimbursed by insurance with an “add-on” while non-approved indications come out of the hospital budget; (2) Extramurally (community pharmacies) where Ig is completely reimbursed by health insurance irrespective of the indication.17 Ig is reimbursed for on-label usage and for certain off-label indications, which are based on several guidelines and clinicians´ input.18 Sanquin is the only blood bank in the Netherlands legally tasked to collect the amount of Dutch plasma necessary for self-sufficiency. Sanquin Plasma Products (SPP) was a pharmaceutical company that was originally part of the Sanquin Blood Supply Foundation. Albeit now separate, SPP (now Prothya Biosolutions) is still connected to Sanquin and continues its role in obtaining Dutch plasma for fractionation in order to manufacture plasma-derived medicinal products (PDMPs) for the Netherlands.19 Methodology From February to June 2019, we combined a scoping review with semi-structured interviews. Following scenario principles, this concurrent methodology was considered ideal to answer the research objectives to examine the topic from existing literature and compare it with the perspectives of experts in the field.
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