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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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Dutch Healthcare Institute updated the framework for the assessment of the technologies for inclusion in the Basic Health Insurance

According to the Dutch Health Insurance Act, only medical care that is effective and complies with the "state of science and practice" criteria can be reimbursed under the basic health insurance package. Based on the “state of science and practice” criteria, the Dutch Healthcare Institute (ZIN), health insurers, and healthcare providers examine whether care has sufficiently proven effectiveness. The "state of science and practice" criteria are the legal criteria that medical care must meet to be eligible for inclusion in the Basic Health Insurance Package.

On April 11, 2023, the ZIN published the 2023 version of the assessment framework of the "state of science and practice" criteria, including the assessment framework itself, modules with additional explanations for its application, and other information material.

In the update of the assessment framework, the ZIN, among other things, answers questions from society and politics about the future-proofing of the "state of science and practice" criteria due to continuous developments in healthcare. The updated version provides more insight into the flexibility of the assessment framework when dealing with uncertainties about care effectiveness (for example, in innovative care and treatments for rare diseases).

For some treatments or forms of care, further questions may exist about applying the "state of science and practice" assessment framework. To address these questions, ZIN introduced modules with explanations and further elaboration. All modules will belong to the assessment framework and do not form a separate framework. The "state of science and practice" assessment framework remains the leading for all situations. The first module published by ZIN is intended to assess the "state of science and practice" criteria for tumor-agnostic drugs and other oncology drugs studied exclusively in single-arm studies.

The full details in Dutch can be found here.

This news is just one of about 300 market access news collected by our team in the subscription services "HTA Alerts" and "Reimbursement Alerts" every two weeks from more than 80 organizations. Access our paid subscription services to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). Contact us to get a free, three-month, no-obligation trial.