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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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Research project to analyze factors besides clinical evidence, influencing reimbursement decisions or the hospital benefit catalog 2010-2020, started in Austria

22 Sep 2020

Earlier in September 2020, the Austrian Institute for Health Technology Assessment (AIHTA) published a synopsis of the ongoing research project “Reimbursement decisions for medical procedures in Austria: An analysis of factors – besides clinical evidence – influencing reimbursement decisions for the hospital benefit catalog 2010-2020.”

The project aims to identify specific factors besides clinical evidence that play a pivotal role in the Austrian decision-making process for medical procedures utilizing medical devices, and answer to the following research questions:

  • What role did clinical evidence play in the reimbursement process for individual medical services (Medizinische Einzelleistung; MEL) in Austria over the past ten years?
  • What were other factors taken into account in the reimbursement process to come to a decision that deviates from the evidence-based recommendation?

MEL assessments by the AIHTA and subsequent decisions on the annual maintenance of the Austrian service catalog between 2010 and 2020 are analyzed using a mixed-methods approach.

In the first step, the data from the MEL assessments carried out and the subsequent reimbursement decisions are analyzed using descriptive statistical methods. The existing data set of the AIHTA (data input up to 2016) is completed and represents the data basis for the analysis. Relevant variables include information from HTA reports such as intervention, risk class of the medical device, and quality of the evidence as well as the final reimbursement decisions (mid-September - mid-October 2020).

In the second step, MELs with a decision that deviates from the evidence-based recommendation are identified. This is followed by semi-structured interviews with decision-makers in order to identify further factors that can influence the reimbursement of MELs - without sound scientific clinical evidence (mid-October – mid-November).

The full report in German can be found here

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