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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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Permanent reimbursement for next-generation sequencing (NGS) in oncology launched in Belgium

Molecular biology tests by next-generation sequencing (NGS) in oncology and hemato-oncology have been temporarily reimbursed as a pilot in a limited number of centers under a specific agreement (Convention) with the National Institute for Health and Disability Insurance (INAMI/RIZIV) from July 2019 to June 30, 2024. 

On July 1, 2024, a new agreement (Convention) came into force, which allows permanent reimbursement via newly introduced Pseudo-nomenclature codes with fees. The pseudocode descriptions specify the indication, while certain biomarkers and reimbursement conditions are mentioned as notes to the code.

In addition to "classic" NGS, which allows the DNA sequence of genes or gene fragments to be determined, the agreement also allows reimbursement of "RNA-Seq" NGS for the analysis of genetic rearrangements and homologous recombination deficiency (HRD) test in combination with NGS in certain indications.

The pseudocodes (indications) with eligible biomarkers, reimbursement fees, and other conditions are determined in two lists (Annexes to the Convention) separately for solid tumors (28 codes) and malignant hematological diseases (23 codes). Some examples of new pseudocodes are provided below:

  • 535010-535021 NGS for metastatic colorectal cancer;
  • 535054-535065 NGS for squamous lung cancer;
  • 535216-535220 RNA-Seq for diffuse glioma, circumscribed glioma, or ependymoma;
  • 535570-535581 NGS for acute myeloblastic leukemia at diagnosis;
  • 535614-535625 RNA-Seq for acute myeloblastic leukemia;
  • 535975-535986 Screening for acquired chromosomal or genetic abnormalities (except rearrangement of immunoglobulin genes or T-cell receptor genes) using a molecular biology method: in the diagnostic investigation phase of acute myeloblastic leukemia or myelodysplastic syndrome with increased blasts (RAEB-2).

See the full details in French here.

This news is just one of about 300 market access news collected by our team in the premium subscription service Market Access Monitor every week from more than 80 organizations. Access our paid service to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). Access is organized as an online Database and email alert formats. Contact us to get a free, three-month, no-obligation trial.