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Procedure coding
Typically, procedure coding is well-established for EVAR in European countries.
Procedure codes for EVAR may differ depending on the anatomical part of the aorta (e.g., thoracic aorta, abdominal aorta, etc.) and the type of graft (e.g., number of fenestrations, branches, etc.).
For example, in Germany, OPS procedure coding for endovascular implantation of stent grafts in the abdominal aorta distinguishes between stent graft without opening (code 5-38a.c0), stent graft with one opening (code 5-38a.c1), stent graft with two openings (code 5-38a.c2) or stent graft with three or more openings (code 5-38a.c3).
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Payment mechanism
The payment model varies by country.
In many EU countries, the EVAR is reimbursed via the diagnosis-related group (DRG) mechanism.
In some countries (e.g., France and Germany), devices for EVAR attract additional (top-up) reimbursement, which is paid in addition to the DRG tariff.
For example, in Germany, several add-on ZE categories exist depending on the type of stent graft (depending on the number of fenestrations), with pricing mainly determined locally.
Add-on reimbursement can be either generic (at the class level, as in Germany) or brand-specific (with specific LPPR codes for individual brands in France).
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Policy considerations
Due to high costs, EVAR can be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist.
For example, in England, the national payer, NHS England, developed the clinical commissioning policy “Use of Complex Endovascular Stent Grafts in the Management of Abdominal Aortic Aneurysm”, in which NHS England outlined categories of patients eligible for elective EVAR surgery.
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Health technology assessment
Due to established reimbursement in European countries, EVAR rarely becomes a subject of HTA.
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Future challenges
EVAR has established reimbursement and funding in most of the European countries. New health technology assessments are unlikely to be relevant.
Novel devices for EVAR with unique designs and properties or different cost profiles might need to develop specific procedure codes and adjust payment mechanisms to leverage their unique technology or cost profile fully.
An important topic for EVAR is the establishment of reimbursement and funding for devices used in secondary procedures in patients with an existing EVAR.
How can MTRC help?
Development of reimbursement analysis (procedure coding, payment mechanism, reimbursement tariffs, and policy considerations)
Development of reimbursement strategy
Development of the value dossier
Performing evidence gap analysis for novel technologies
Development of reimbursement and HTA submission dossiers
Adaptation of the global health economic model to EU settings
MTRC has experience with more than 3 projects related to EVAR in Europe
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