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Percutaneous left appendage occlusion

An overview of market access challenges for percutaneous left appendage occlusion in European countries


Procedure coding

Procedure coding for percutaneous left appendage occlusion is well-established in many European countries. For example, in England, a specific OPCS code K62.5 “Percutaneous transluminal occlusion of left atrial appendage” exists to cover the procedure. 

In some countries, procedure codes for percutaneous left appendage occlusion differ depending on the type of device used. For example, in Germany, OPS procedure coding distinguishes between implanting a permanent embolic protection system (code 8-837.s0) and closure using a snare inserted percutaneously in the epicardial area (8-837.s1).


Payment mechanism

The payment model varies by country.

In some European countries (Germany, Italy, and countries of the Nordic region), percutaneous left appendage occlusion is reimbursed solely via the diagnosis-related group (DRG) mechanism. For example, in Germany, the procedure is allocated to the DRG F95A “Interventional septal closure or closure of a paravalvular leak with a cardiac occluder, age <18 years or atrial appendage occlusion” with a tariff of €9,162 for ordinary length of stay.

In some countries (e.g., France and England), percutaneous left appendage occlusion devices attract additional reimbursement, paid on top of the DRG tariff. For example, in England, there is a specific category in the High Cost Devices List “Occluder, Vascular, Appendage and Septal devices”.

In France, add-on reimbursement for percutaneous left appendage occlusion devices is typically brand-specific: brand-specific LPPR codes for four devices have a tariff range of €4,417.5 - €4,650. 


Policy considerations

Due to the innovative origin of the procedure, percutaneous left appendage occlusion can be subject to specific policies from payers or national decision-makers in the countries where such frameworks exist. The procedure is reimbursed in many countries only when certain patient eligibility criteria are met.

For example, in England, the national payer, NHS England, published the Clinical Commissioning Policy “Left Atrial Appendage Occlusion for patients with atrial fibrillation and relative or absolute contraindications to anticoagulation (adults)”. The procedure is routinely commissioned for patients with non-valvular atrial fibrillation and absolute and relative contraindications to oral anticoagulants, according to the criteria defined in the Policy. 

In several European countries, the coverage policies for percutaneous left appendage occlusion are under development. For example, in the Netherlands, percutaneous left appendage occlusion, which is currently not covered under basic health insurance, was awarded the "Subsidy scheme for promising care" (coverage with evidence development program) in 2020 and will be assessed for coverage at the national level upon the completion of the study (approximately in 2026). 


Health technology assessment

As the method is rather well-established in most European countries, novel HTAs are unlikely. 


Future challenges 

Percutaneous left appendage occlusion has established reimbursement and funding in most European countries. New health technology assessments are unlikely to be relevant. 

Novel devices for percutaneous left appendage occlusion with unique designs might need to develop specific procedure codes and adjust payment mechanisms to leverage their unique technology or cost profile fully. 

MTRC has experience with more than 5 projects, related to percutaneous left appendage occlusion in Europe

News and insights

Rapid HTAs of nine medical devices released in Tuscany

The HTA body of the Tuscany Regional Healthcare issues two types of documents: HTA forms and motivational forms. With regional decree 10778 of June 01, 2022, Tuscany Regional Healthcare has published assessments of nine medical devices in various therapeutic areas, such as cardiovascular and peripheral vascular areas, surgical procedures, orthopedics, and dermatology.

HTA of left atrial appendage closure in Austria

On 20th of July, 2018, the Austrian HTA body, the Ludwig-Boltzmann Institute (LBI) has published an assessment of left atrial appendage closure to prevent stroke to determine national coverage of the procedure. Considering this evidence, the authors do not recommend the inclusion in the hospital benefit catalogue, neither for percutaneous left atrial appendage occlusion nor for surgical closure using a special clip.

New funding decisions by NHS England

Hundreds of patients each year will benefit from fourteen new innovative treatments that will now be routinely available. These treatments include several devices and procedures: keraprosthesis for corneal blindness, left atrial appendage occlusion, selective dorsal rhizotomy and total pancreatectomy with islet transplantation for chronic pancreatitis.

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