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Cost-efficient European adaptations of global health economic models

Experience with model adaptations in Austria, Belgium, France, Germany, Italy, Norway, Netherlands, Spain, Sweden, the UK

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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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Evidence-based Interventions (EBI) Programme List 3 was published in England

In May 2023, the Academy of Medical Royal Colleges (AoMRC) published the latest set of guidance (List 3) of the Evidence-based Interventions (EBI) Programme. The program is supported by NHS England, NHS Confederation, the Patients Association, the National Institute for Health and Care Excellence (NICE), and Getting it Right First Time (GiRFT). It was established in 2018 to ensure a national approach to quality improvement and spread the best practice in healthcare, reducing unwarranted variation across the country.

The EBI Program develops sets of guidance (Lists) for procedures, treatments, care pathways, and diagnostic tests based on recommendations from the Expert Advisory Committee and NICE assessments. It is expected that where treatment criteria (the threshold) are met, the procedures or pathways in question will be routinely funded by the local commissioner without any need to apply for prior approval. EBI is part of the NHS Standard Contract, which is mandated by NHS England for use by commissioners for all contracts for healthcare services other than primary care. However, EBI recommendations are guidance and not a statutory requirement.

List 1 (17 interventions) was published in 2018, and List 2 (31 interventions) in 2020.

The List 3 covers ten interventions across a range of medical specialties, including breast surgery, gastrointestinal surgery, cardiovascular, urology, and ophthalmology.

An example of the new guidance is the referral for bariatric surgery in adults. Various surgical options include Roux-en-Y gastric bypass, one anastomosis (mini) gastric bypass, vertical sleeve gastrectomy, and adjustable gastric banding. The guidance provides certain criteria for referral to a bariatric surgical center, which should be met, e.g., for patients with a BMI of 50 kg/m2 or more, surgery should be considered as a first-line treatment intervention.

See the full details 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.