"The evaluation of the benefits and harms of medical procedures following the methods of evidence based medicine is one of the main principles of every health technology assessment."
– Dr. Prof. Jürgen Windeler, Director, IQWiG
History and structure
With the introduction of the healthcare reform in 2003 (Health Care Modernization Act), legislation enabled the establishment of a new institute, independent of the state, within the German healthcare system. In June 2004, the Federal Joint Committee (Gemeinsamer Bundesausschuss) set up the Institute for Quality and Efficiency in Health Care (IQWiG) as a non-profit, non-government, private foundation with legal status. (The Federal Joint Committee is the decision-making body for self-administration of German healthcare services.)
The Institute is an establishment of the Foundation and under independent scientific management. The Foundation's governing bodies include the Foundation Council and Board of Directors. The Institute's advisory committees are the Board of Trustees and the Scientific Advisory Board.
IQWiG is financed by contributions from the statutory health insurance and may also accept funding from the Federal Ministry of Health.
The Institute's primary goal is to contribute to improvements in health care in Germany. IQWiG undertakes and publishes assessments addressing the effectiveness, quality, and efficiency of health services, and is particularly active in the following areas: evaluation of the benefits and harms of drug and non-drug interventions, evaluation of evidence-based guidelines for diseases of the greatest epidemiological importance, and provision to the public of easily understandable general information on the quality and efficiency of health care.
IQWiG's responsibilities were expanded in two health care reforms in 2007 and 2010. With the "Act to Promote Competition" of statutory health insurance (GKV Wettbewerbsstärkungsgesetz 2007) the Institute can be commissioned to weigh the costs of drug therapies against the benefit previously determined. Prior to that, the assessment of drugs was restricted to the medical benefit (i.e. to the evaluation of benefits and harms of drug interventions). With the "Law on the Reorganization of the Pharmaceutical Market” (Arzneimittelmarktneuordnungsgesetz AMNOG, 2011) it became the responsibility of the Federal Joint Committee to assess the benefit of newly approved drugs. If an additional benefit has been established, the price of the new medicine will be negotiated between the Central Federal Association of the Health Insurance Funds and the company concerned. The assessment is performed on the basis of dossiers that the manufacturers are obliged to submit to the Federal Joint Committee, which then generally commissions IQWiG with the assessment of the dossiers.
How IQWiG Works
The Institute produces reports on specific topics requested by the Federal Joint Committee or the Federal Ministry of Health, following the principles of evidence-based medicine. IQWiG also undertakes projects and research work on its own initiative. The work of the Institute's staff is supplemented by the external contracting of projects, which are advertised publicly. Work on these projects must be conducted according to the current methods of the Institute (the English version is available under https://www.iqwig.de/index.925.en.html).
Stakeholders and the interested public can also become involved in the work of the Institute. IQWiG publishes all results of its work on the Internet, and interested persons and parties may submit written comments on report plans (protocols) and on the preliminary reports. This written hearing may lead to changes in the final report.
IQWiG publishes its methods and the preliminary and final results of its work on the website www.iqwig.de. This information is targeted towards a scientific audience.
As part of its legislative mandate to inform the public, IQWiG also publishes a bilingual website for consumers and patients (www.gesundheitsinformation.de; www.informedhealthonline.org). The website includes information based on the Institute's own scientific publications and on topics it chooses. The website will also include items of patient information commissioned by the Federal Joint Committee or Federal Ministry of Health.
Dissemination activities involve communication with the media, as well as the organization of and participation in scientific meetings and workshops.
The Federal Joint Committee has awarded a series of research commissions, ranging widely in content, to the Institute. Among other projects, the Institute analyses drug therapies in comparison to each other and to non-drug therapies for widespread diseases, e.g., diabetes mellitus types 1 and 2, hypertension, asthma, depression and dementia. Further responsibilities include evaluation of the following topics: stem cell transplantation for selected indications (e.g., Hodgkin’s lymphoma); brachytherapy in patients with early-stage prostate cancer; measurement of bone density; positron emission tomography (PET) and PET/computer tomography for 14 indications; and the quality of health care in children with cancer.
IQWiG is also developing a methodology to assess clinical practice guidelines.
It is essential to IQWiG to initiate and maintain reliable and stable cooperation with external partners. We are therefore forming and financially supporting a worldwide network of research groups to recruit external experts on a long-term basis. We are actively developing our national and international collaboration. IQWiG has established regular exchanges with its counterparts in France (HAS) and Britain (NICE). As a first step, we are discussing our respective methods and assessing whether and to what extent they are compatible. Our long-term aim is to foster better and broader cooperation, including the exchange of methods and results with several countries.
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Director: Dr. Prof. Jürgen Windeler
Contact person: Dr. Alric Rüther
Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen
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