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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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Updates in Annexes of the Swiss Services Ordinance (KLV/OPre)

In mid-June, the Swiss Federal Office for Public Health announced the update of the Annexes of the Services Ordinance (KLV/OPre). More specifically, the following updates are announced:

Changes in Annex 1 of the Services Ordinance (explicitly evaluated services with coverage decision), to enter into force on July 1, 2022:

  • Embolization of the prostatic arteries for symptomatic benign prostate hyperplasia will be reimbursed (Coverage with Evidence Development) until the end of 2024. This is only valid for patients with moderate to severe obstructive symptoms (IPSS > 8, QoL > 3) and benign prostate hyperplasia > 30-50 mL and the presence of at least one of the following criteria:
    • Failure of pharmacological therapy;
    • Intolerance to medicines;
    • Chronic urinary retention without prostate volume limits;
    • Concern that problems such as retrograde ejaculation, erectile dysfunction, or urinary incontinence will occur ;
    • Surgery contraindicated due to age, multiple comorbidities, or coagulopathies ;
    • Surgery refused by the patient.

Changes in Annex 2 of the Services Ordinance (List of means and devices), to enter into force on July 1, 2022 and on October 1, 2022:

  • From July 2022, there are many changes in reimbursement tariffs of aids, as well as and the change in the way of reimbursement of certain aids;
  • From July 2022, the category "21.06 Glucose measurement system based on precalibrated sensors with visualization of values on request" (Flash Glucose Monitoring) is now fully reimbursed (not in evaluation anymore). There are no changes in the reimbursement of the reader, while the sensors will now be reimbursed per diem at a daily tariff of 4.83 CHF;
  • From October 2022, the chapter 3 "Appliances” will be thoroughly reformed (many categories of devices will be added, many will be removed).

Changes in Annex 3 of the Services Ordinance (List of analyses) to enter into force on July 1, 2022 and on August 1, 2022:

  • Three new tests will be introduced in July 2022:
    • Code 1563.00, Free metanephrines, with the tariff of 162 CHF;
    • Code 1564.00, Total metanephrines, with the tariff of 125 CHF;
    • Code 3186.10, SARS-coronavirus-2 (SARS-CoV-2), additional microorganism, with the tariff of 53 CHF;
  • From August 1, 2022, all tests in the list will have a 10% reduction in reimbursement tariffs. Further reductions are expected until 2025.

Minor updates in the text of the Services Ordinance (KLV/OPre) (related to COVID19 vaccination), have also entered into force on July 1, 2022.

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). First EU issues of both newsletters are available for download free-of-charge.

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