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Cost-effective reimbursement analysis for medical technologies in Europe

Procedure coding, payment mechanism, reimbursement tariffs, policy, and HTA considerations in 34 EU countries

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Reimbursement summary for angioplasty of arteries of lower extremities

This post presents an extract from our reimbursement analysis for angioplasty of arteries lower extremities using plain and drug-coated balloons (DCBs) for peripheral artery disease in England, France and Germany. Plain balloon angioplasty is reimbursement via DRG solely and DCBs are reimbursement via combination of DRG and add-on reimbursement.
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The amended 2023/25 NHS Payment Scheme in England came into force on April 1, 2024

On April 1, 2024, the amended 2023/25 NHS Payment Scheme (NHSPS) came into force. 2023/25 NHSPS was set for two financial years (starting in April); however, following consultation, some amendments were made to the NHSPS for 2024/25.

No changes were made to the general payment model. The key payment mechanism remains the aligned payment and incentives (API).

The key implemented changes related to Med Tech are presented below.

Two new categories were added to the regular High Cost Devices List (HCDL), for example, an implantable pulmonary artery pressure sensor. 

Six devices were added to HCDL under a new process being developed by NHS England’s SSDP (Specialised Services Devices Programme) in partnership with NICE. Examples of included devices are percutaneous left ventricular-assist devices (IPG633), hypoglossal nerve stimulation, or upper airway stimulation (IPG598). 

The SSDP NICE ‘Special Arrangements’ process applies to specified devices recommended by NICE IPG (Interventional Procedure Guidance) to be used with ‘special arrangements’. These devices will only be reimbursed through SSDP if the following conditions are met: 1) the device is either part of a specialized pathway or would be covered by an existing excluded category, which is the commissioning responsibility of NHS England; 2) the device is high-cost and a barrier to providers using without reimbursement; 3) the device has a relatively recent published NICE IPG; 4) the device has been submitted to the Device Steering Group and been supported. The process will include further analysis of cost-effectiveness for the NHS and will involve a prioritization process. Reimbursement will be limited to providers who agree with the supplier and are able to support the evaluation. Reimbursement will only be made if providers follow the relevant NICE guidance and confirm the data submission to NHS England and/or the device supplier.

New reimbursement codes and tariffs (unit prices) for the following three types of specialist radiotherapy were introduced: Stereotactic radiosurgery/radiotherapy (SRS/T), stereotactic ablative radiotherapy (SABR), and selective internal radiation therapy (SIRT). Unit prices are part of the variable (activity-based) component of the API model (used for actual reimbursement).

One new product was included in the MedTech Funding Mandate: AposHealth, a non-invasive device worn on the feet to reduce pain and improve function in patients with knee osteoarthritis.

Furthermore, HRG tariffs (prices workbook, Annex A) were updated to reflect the 2024/25 cost uplift and efficiency factors.

See the full details here.

This news is just one of about 300 market access news collected by our team in the premium subscription service Market Access Monitor every week from more than 80 organizations. Access our paid service to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). Access is organized as an online Database and email alert formats. Contact us to get a free, three-month, no-obligation trial.