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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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Disease management program for osteoporosis will be implemented in Germany

The patients diagnosed with osteoporosis requiring medication will be able to receive care within a structured treatment program (disease management program, DMP). The Federal Joint Committee (G-BA) decided in mid-January 2020 the details of participation and the various aspects of care.

The scientific basis of the new DMP is the guideline search of the Institute for Quality and Efficiency in Health Care (IQWiG), published in April 2018.

The topic was accepted because the necessary criteria were in place: the G-BA had checked whether there were evidence-based guidelines, whether a DMP could improve the existing quality of care and whether the course of the disease could be influenced by the patient's initiative.

Osteoporosis is a skeletal disease in which the density and quality of bone are reduced. As bones become more porous and fragile, the risk of fracture is greatly increased. It is the most common reason for a broken bone among the elderly. Postmenopausal women are affected above average.  

The DMP is aimed at patients with osteoporosis requiring medication. Women can enroll in a DMP from the age of 50, men from the age of 60. The aim of the DMP is, in particular, to avoid (further) bone fractures, to prevent the disease from progressing, and to reduce pain.

The therapeutic measures that the G-BA has included in the DMP requirements must be selected depending on the patient's age and comorbidities. The recommendations for drug therapy are specified for men and/or postmenopausal women. The recommendations for non-drug therapy include, for example, lifestyle-related training, determining the risk of falling from the age of 70, and offering functional training or rehabilitation sports.

The G-BA is now submitting the decision to the Federal Ministry of Health for review. In the case of non-objection, the requirements for the DMP osteoporosis will take effect on the first day of the quarter following the publication in the Federal Gazette.

The new DMP will be available for patients as soon as the statutory health insurance companies will conclude contracts with doctors and/or hospitals for the practical implementation of the DMP.

DMP requirements for rheumatoid arthritis are also currently being developed at the G-BA. The decision is planned to be made in 2020.

The full details in German can be found here.

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