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Ablation of heart tissue

An overview of market access challenges for ablation of heart tissue in European countries

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Procedure coding

Typically, procedure coding is well-established for the ablation of heart tissue in European countries.  

In many countries, there are multiple procedure codes for the ablation of heart tissue, which differ depending on the type of energy used (radiofrequency, cryoablation, etc.), anatomical site of intervention (right atrium, pulmonary vein isolation, etc.), the type of approach (open, thoracoscopic or percutaneous endovascular) or access to the site of intervention for percutaneous ablation (transvenous, transseptal, etc.).

For example, in Austria, procedure codes for percutaneous cardiac ablation include code DE060 “Catheter ablation of the cardiac conduction system in the pulmonary vein” and code DE050 “Catheter ablation of the cardiac conduction system”.

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Payment mechanism

The payment model for ablation of heart tissue is DRG in most European countries.

In some countries, the DRG allocation depends on the anatomical site (e.g., Germany, the Netherlands or Switzerland). In other countries, the type of energy used impacts the DRG allocation. For example, in Switzerland percutaneous cryoablation of heart tissue is reimbursed via DRG F50B “Ablative measures for tachyarrhythmia with complex surgery, age > 15 years” with higher tariff of €12,990 compared to radiofrequency ablation, which is allocated to the DRG F50C “Ablative measures for tachyarrhythmia with certain ablation, age> 15 years” with a tariff of €10,956.

In most European countries, the devices for cardiac ablation do not attract additional (top-up) reimbursement, which is paid in addition to the DRG tariff. One of the exceptions is England, where radiofrequency, cryotherapy, and microwave ablation probes and catheters are included in the High Cost Devices List and reimbursed in addition to the HRG tariff.

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Policy considerations

Due to the high prevalence of cardiac arrhythmias, ablation of heart tissue can be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist. 

For example, in December 2022, NHS England, a national payer, published a Clinical Commissioning Policy on catheter ablation for adult patients with paroxysmal and persistent atrial fibrillation. NHS England will routinely commission catheter ablation as a treatment option for paroxysmal and persistent atrial fibrillation within the criteria set out in the policy. 

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Health technology assessment

Due to established reimbursement in European countries, devices for ablation of heart tissue rarely become a subject of HTA. However, there can be exceptions related to novel types of ablative technologies. For example, in England, NICE is awaiting the development of the HTA for pulsed-field ablation in atrial fibrillation. 

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Future challenges 

Ablation of heart tissue using standard techniques and energy sources has established reimbursement and funding in most European countries. New health technology assessments are unlikely to be relevant. It is unlikely to benefit from the innovative payment schemes. 

Novel devices for cardiac ablation with unique designs or alternative energy sources might need to develop specific procedure codes and adjust payment mechanisms to leverage their unique technology or cost profile fully. 

MTRC has experience with more than 6 projects related to the ablation of heart tissue in Europe

News and insights

Rapid HTAs of three medical devices released in Tuscany

The HTA body of the Tuscany Regional Healthcare issues three types of documents: full HTA reports, rapid HTA reports, and motivational forms. With regional decree 4588 of March 5, 2024, Tuscany Regional Healthcare published two new assessments and one re-assessment of medical devices in the cardiovascular, neuromodulation, and surgical procedures areas.

Recommendations about add-on reimbursement for medical devices in France in November 2023

The French National Authority for Health (HAS) released new recommendations about add-on reimbursement of medical devices and medical aids from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in November 2023. Seven recommendations were published in relation to the registration of medical devices in the List of reimbursable products and services (LPPR). Opinions concern cardiovascular, nephrology and urology, and orthopedic devices, as well as medical aids.

Rapid HTAs of two medical devices released in Tuscany

The HTA body of the Tuscany Regional Healthcare issues three types of documents: full HTA reports, rapid HTA reports, and motivational forms. With regional decree 24192 of November 15, 2023, Tuscany Regional Healthcare published one assessment and one re-assessment of medical devices in the cardiovascular and men's health areas.

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