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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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Report on the clinical utility of radiofrequency tonsil reduction in Spain

Tonsils hypertrophy is a prevalent finding in children which could lead to continuous infections of the upper respiratory airways (tracheitis, rhinitis pharyngitis and laryngitis), acute otitis, severe and mucoid otitis, sinusitis and coughing. It can lead to the obstructive sleep apnoea hypopnea syndrome, too. Adenoidectomy and tonsillectomy and are the best treatment for most children with this syndrome.

Tonsillectomy is usually carried out using a cold scalpel technique or electrocautery under general anesthesia, which is considered “traditional tonsillectomy.” Lately, seeing that enlargement of the tonsils is the leading indication for this type of surgery has led to the introduction of new techniques, which seek to diminish the volume of the tonsils (tonsillotomy or tonsillar reduction). With these techniques, the objective is to lower the rates of both intra- and postoperative bleeding and pain.

OSTEBA has performed a systematic review of the scientific evidence in order to compare the clinical utility (safety, morbidity and effectiveness) of radiofrequency tonsil reduction with that of traditional tonsillectomy and other surgical options for enlarged tonsils. They have gone through scientific databases, critical analysis of studies to determine the reliability of the evidence, and summary of the findings, which were then assessed in relation to the context of the Spanish NHS. Thus, this is not an economic analysis nor expert opinion.

Consistent results indicate that the tonsillar radiofrequency reduction is less uncomfortable and requires less recovery time after the surgery when compared to traditional tonsillectomy. Comparison of safety and effectiveness of the two techniques did not show a significant difference, but the evidence for assessing these two characteristics was poor.

Furthermore, the evidence demonstrates that tonsillar radiofrequency reduction and tonsillar coblator reduction are safer than laser and tonsillectomy with cautery. However, the authors could not conclude about the differences in effectiveness between these techniques used for the tonsillar reduction.  The authors also claim that further studies are required, with a greater number of patients, with better control of bias and longer follow-up in order to draw good conclusions.

See the full report in Spanish (with summary in English and Basque) here.

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