Three medical procedures covered with evidence development in Switzerland

10

Jan 2018

According to the principle of trust, medical services including devices and in-vivo diagnostics are covered by Swiss statutory health insurance (SHI) scheme without formal health technology assessments (HTA). However, in case of doubt that a medical service is effective, appropriate and efficient, it can be reported to the Federal Office of Public Health (FOPH) who reviews the available evidence on effectiveness, appropriateness, and cost-effectiveness of the method. The Department of Home Affairs (EDI) takes the final decision about the coverage of the service in the form of one of three possible outcomes:

•          Yes – continued coverage

•          No – exclusion from coverage

•          Yes, in evaluation – coverage while further evidence is collected

The status “Yes, in evaluation” can be connected to conditions as to lead a patient-based register or that reimbursement is limited to specific indications, centers or medical specialists. The status is set for a specific period which is extended until evidence is complete and can be considered as coverage with evidence development (CED) scheme.

On January 1st of 2018, this status was given to following medical services:

  • Positron emission tomography (PET, PET / CT) in the question "Massaging", according to the clinical guidelines of the SGNM, chapter 2.0, dated April 28, 2011 on FDG-PET. Status valid until 31.12.2018
  • Positron emission tomography (PET, PET / CT) using 18F-fluorocholine to clarify biochemically proven recurrence (PSA increase) of a prostate carcinoma. Status valid until 31.12.2018
  • Ambulatory stereotactic radiotherapy (photons) of exudative age-related macular degeneration if conditions below are met. Status valid until 30.6.2020
    • Choroidal neovascularization (CNV) with signs of activity such as intraretinal fluid or hemorrhage
    • Ongoing anti-VEGF therapy over a period of at least six months and thus exclusion of an under-treatment
    • No change in CNV activity status despite intensive injection therapy and no expected decline in the need for a high frequency of treatment in the future
    • Diameter of CNV maximal 4 mm (center maximally 3 mm away from the fovea)

The first two services (positron emission tomography) were given the CED-status previously and it was now renewed until the end of the year. Stereotactic radiotherapy is under CED for the first time in Switzerland.

Decisions by the Department of Home Affairs (EDI) about the coverage of medical services are documented in Annex 1 of the health care benefit ordinance (KLV).

Subscribe to our newsletter delivered every second week not to miss important reimbursement information.

Related news

20

Apr 2018

On 5th of April, 2018, the Board of Directors of SwissDRG SA has given the director the mandate to establish, where appropriate, codifications by analogy in agreement with the Federal Statistics Office (FSO). The regulation from April of 2018 covers CytoSorb for removal of cytokines.

Read more

16

Apr 2018

In February 2018, the DFI (the Federal Department of Home Affairs) has decided to make a change in the activity order (Ordinanza sulle prestazioni, OPre) concerning “out-patient before in-patient.” The modification is coming into force starting January 1st, 2019. Six procedures will be reimbursed only in out-patient settings.

Read more

11

Apr 2018

Eight reimbursement reports with the total size of 882 pages cover the most common radiotherapy modalities including brachytherapy, 3D conformal radiation therapy, stereotactic radiosurgery, stereotactic body radiation therapy, intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), image-guided radiotherapy, proton therapy. The analysis covers procedure coding, payment mechanism, reimbursement tariffs and policy restrictions in 12 EU countries including Austria, Belgium, Denmark, England, Finland, France, Germany, Italy, the Netherlands, Norway, Sweden and Switzerland.

Read more

09

Apr 2018

In April 2018, Danish Health Authority published 163 new codes for the Health Care Classification System, including five diagnosis codes, 34 surgical and 29 medical procedure codes. These codes are used to classify procedures in Danish DRG system.

Read more

28

Mar 2018

The Dutch Healthcare Authority (Nederlandse Zorgautoriteit) has published a draft version of the DBC package for specialist medical care for 2019 (RZ19a).

Read more

27

Mar 2018

The background for updating the National Clinical Guideline for Treatment of Brain Metastases is that local treatment (stereotactic radiation therapy) has gained more space in the treatment of brain metastases.

Read more

26

Mar 2018

The Clinical Coding and Schedule Development Group develops and maintains procedural and diagnostics nomenclature for private payers in England. In February new codes for preparation and delivery of radiotherapy, knee resurfacing arthroplasty, balloon dilatation of the Eustachian tube and MRI-guided focused ultrasound (MRgFUS) thalamotomy for essential tremor were added to the CCSD Schedule.

Read more

23

Mar 2018

Interstitial low-dose rate brachytherapy was commissioned to the Institute for Quality and Efficiency in Health Care (IQWiG) by the Federal Joint Committee (G-BA) in order to analyze the current knowledge on procedure.

Read more

14

Feb 2018

The Dutch Healthcare Authority (Nederlandse Zorgautoriteit) has published a draft version of the DBC package for specialist medical care for 2019 (RZ19a).

Read more

13

Feb 2018

The background for updating the National Clinical Guideline for Treatment of Brain Metastases is that local treatment (stereotactic radiation therapy) has gained more space in the treatment of brain metastases.

Read more

27

Dec 2017

The further-developed tariff structure SwissDRG was approved by the Federal Council in Switzerland. The new tariff version for inpatient services will be effective from January 1st in 2018. The tariff structure SwissDRG defines how inpatient services in the acute care area of the hospitals and birthplaces are reimbursed within the framework of compulsory health care insurance in Switzerland.

Read more

17

Nov 2017

After successful trial application by a manufacturer (St. Jude Medical, now part of Abbott), the Federal Joint Committee (G-BA) decided to conduct a co-funded study to create evidence about the measurement and monitoring of pulmonary artery pressure using an implanted sensor called “CardioMEMS™ HF System” to optimize therapy in NYHA III heart failure. The G-BA released a trial guideline defining the key points of the planned study, including type and duration of the study, target population and control intervention.

Read more

08

Nov 2017

An international advisor group of 14 medical and health economic experts proposed 38 measures of how control the increase of healthcare costs in Switzerland. One third of the actions including the strengthening of HTA are already considered. The Swiss Federal Council now wants to develop concrete plans for the implementation of the new measures suggested in the report by the expert group, including global budgets for the outpatient sector, the introduction of medical boards, the encouragement of parallel imports of medical technology and implants and annual review of prices.

Read more

13

Oct 2017

SIRT is not routinely commissioned in England. In 2013 NHS England commissioned an evaluation of SIRT for colorectal liver metastases and intrahepatic cholangiocarcinoma within registry in England, complemented by systematic literature review and de novo economic analysis (Commissioning Through Evaluation). In July 2017, NICE prepared a final report for NHS England, which was made public on 12th of October 2017.

Read more

11

Oct 2017

German Federal Joint Committee (G-BA) passed directives for co-funded trials to create evidence on two high-intensity focused ultrasound methods that showed potential benefit in the early benefit assessment process in relation to the innovation funding (NUB). Manufacturer refused to cover required contribution to trial costs and thereby risk exclusion of the methods from benefit catalogues in the German social health insurance.

Read more

25

Jul 2017

SwissDRG has released overview of planned update of DRG system (version 7.0) in 2018, including list of preliminary approved add-on reimbursement categories. Add-on will be established for endobronchial valves, proton therapy, autologous matrix-induced chondrocyte implantation at knee joint and intermitted hemodialysis for removal of proteins with molecular mass up to 60,000 Da.

Read more

21

Apr 2017

SwissDRG has released the application form for suggestions for DRG change in 2017. Applications will be collected between 29th of May and 10th of July 2017. Approved changes will be implemented in 2019.

Read more