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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 Programme List 3 will include 17 new interventions in England

On January 20, 2022, the Academy of Medical Royal Colleges (AoMRC) launched a consultation on the latest set of guidance (List 3) of the Evidence-based Interventions (EBI) Programme. The deadline for comments submission is March 31, 2022.

EBI Programme is a joint enterprise between the AoMRC, NHS Clinical Commissioners, the National Institute for Health and Care Excellence (NICE) as well as NHS England and Improvement.

EBI program develops guidance sets (Lists) for tests, treatments, and procedures based on recommendations from the Expert Advisory Committee and NICE assessments. The guidance is aimed to support clinicians in improving patient outcomes and commissioners in developing their policies. List 1 (17 interventions) was published in 2018, List 2 (31 interventions) in 2020.

The guidelines provide clear, evidence-based criteria for consideration about the use of each intervention. The implementation of this proposed guidance would result in a reduction in unwarranted variation across England by standardizing the criteria.

Proposed List 3 covers 17 interventions across a range of medical specialties.

Breast Surgery:

  • Male gynecomastia reduction surgery;
  • Breast prosthesis removal;
  • Corrective surgery for congenital breast.

Cardiology: Angioplasty for PCI (percutaneous coronary intervention) in stable angina.

Endocrinology: Thyroid nodule referral and investigation.

Vascular:

  • Asymptomatic carotid artery stenosis screening;
  • Management of Abdominal Aortic Aneurysms (AAAs).

Gastrointestinal Surgery: Referral for bariatric surgery.

Ophthalmology:

  • Optical coherence tomography (OCT) use in diabetic retinopathy referral;
  • Shared decision-making for cataract surgery;
  • Glaucoma referral criteria.

Urology:

  • Non-visible haematuria;
  • Needle biopsy of the prostate;
  • Penile circumcision.

Plastic Surgery:

  • Abdominoplasty or Apronectomy;
  • Liposuction;
  • Diastasis recti repair.

See the full details here.

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