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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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Changes in the Swiss coverage of several hospital services

The Swiss Services Ordinance (KLV/OPre) is the document that defines the health care services which are covered by the compulsory health insurance in Switzerland. It is updated annually (with more frequent updates possible); thus, the 2020 version is released.

A certain number of minor changes have been made in the body of the text of the KLV/OPre document. Annex one of the KLV/OPre document contains the list of services that are explicitly covered by the compulsory health insurance in Switzerland. The coverage of some services has been extended past January 1, 2020. Here is the list of those services:

  • Autologous transplantation of chondrocytes is still under evaluation; thus, it is covered under certain conditions until 31.12.2020.
  • Extracorporeal photopheresis is still under evaluation (in case of obliterating bronchitis syndrome following lung transplantation); thus, it is covered under certain conditions until 31.12.2021.
  • Transcatheter aortic valve implantation (TAVI) is still under evaluation; thus, it is covered under certain conditions until 30.06.2020.
  • Ultrasound therapy focused on the pallidum, thalamus and subthalamus is still under evaluation; thus, it is covered under certain conditions until 30.06.2020.
  • CAR-T cell therapies (Tisagenlecleucel and Axicabtagen-Ciloleucel) are reimbursed, under certain conditions, since 1.1.2020., until 31.12.2022.
  • Tomography with positron emission (PET/CT), in the case of the "mass effect" indication, is still under evaluation; thus, it is covered under certain conditions until 31.12.2020.
  • Tomography with positron emission (PET/CT), for the preoperative localization of parathyroid adenomas in case of primary hyperparathyroidism after a conventional negative or inconclusive diagnostic imaging, is still under evaluation; thus, it is covered under certain conditions until 30.06.2020.
  • Stereotactic radiation therapy (photons) of wet age-related macular degeneration is still under evaluation; thus, it is covered under certain conditions until 30.06.2020.
  • Deep local oncological hyperthermia in combination with external radiotherapy or brachytherapy, is covered under certain conditions until 31.12.2020.

See the 2020 version of the Services Ordinance KLV/OPre and its Annex 1 in Italian (change the language in the top-right corner) here.

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