Extra-corporeal membrane oxygenation (ECMO) for pulmonary and cardiac failure

Series
External life support
Status
Published
Date
Number of report
034

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The report presents a summary of reimbursement situation for Extra-corporeal membrane oxygenation (ECMO) for pulmonary and cardiac failure.

Both veno-venous and veno-arterial ECMO is considered.

The use of ECMO is considered in the following situations:

  • Acute respiratory distress syndrome (VV-ECMO)
  • Deterioration of chronic advanced heart failure (VA-ECMO)
  • Post-cardiotomy cardiogenic shock (VA-ECMO)
  • Post-myocardial infarction cardiogenic shock (VA-ECMO)

The only reimbursement within public / statutory health insurance systems is considered.

Report includes essential information about reimbursement and national funding, including:

  • Brief overview of reimbursement system for medical devices
  • Procedure coding for technology
  • Diagnosis coding
  • Payment mechanism for technology
  • Reimbursement tariffs for technology
  • Restrictions in indications or scenarios for use of technology
  • Policy considerations by payers and policy-makers about technology

Reimbursement information is provided for the following geographies:

  • Austria
  • Belgium
  • Denmark
  • England (UK)
  • France
  • Germany
  • Italy
  • Netherlands
  • Norway
  • Sweden
  • Switzerland

Manufacturers of extra-corporeal membrane oxygenation devices for pulmonary and cardiac failure report include:

  • Abbott Vascular (CentriMag, PediVAS)
  • Fresenius / XENIOS AG (Medos device)
  • Getinge (CARDIOHELP System, Rotaflow Centrifugal Pump System, PLS System)
  • Hemovent GmbH (Portable ECMO system)
  • Medtronic (BPX-80, BP-50)
  • Terumo (CAPIOX SP Centrifugal Pump)

Table of content
 
1.    Introduction and summary
2.    Contents
3.    Executive summary table
4.    Methodology
5.    Reimbursement analysis in Austria

5.1.    Overview of the reimbursement system
5.2.    Reimbursement for extracorporeal membrane oxygenation
5.2.1.    Procedure coding
5.2.2.    Diagnosis coding
5.2.3.    Payment mechanism and reimbursement tariffs
5.2.4.    Policy considerations
6.    Reimbursement analysis in Belgium
6.1.    Overview of the reimbursement system
6.2.    Reimbursement for extracorporeal membrane oxygenation
6.2.1.    Procedure coding
6.2.2.    Material coding
6.2.3.    Payment mechanism and reimbursement tariffs
6.2.4.    Policy considerations
7.    Reimbursement analysis in Denmark
7.1.    Overview of the reimbursement system
7.2.    Reimbursement for extracorporeal membrane oxygenation
7.2.1.    Procedure coding 
7.2.2.    Diagnosis coding
7.2.3.    Payment mechanism and reimbursement tariffs
7.2.4.    Policy considerations
8.    Reimbursement analysis in England
8.1.    Overview of the reimbursement system
8.2.    Reimbursement for extracorporeal membrane oxygenation
8.2.1.    Procedure coding 
8.2.2.    Diagnosis coding
8.2.3.    Payment mechanism and reimbursement tariffs
8.2.4.    Policy considerations 
8.2.4.1.    Specifics of commissioning of the procedure
8.2.4.2.    Health technology assessments by NICE
9.    Reimbursement analysis in France
9.1.    Overview of the reimbursement system
9.2.    Reimbursement for extracorporeal membrane oxygenation
9.2.1.    Procedure coding 
9.2.2.    Diagnosis coding
9.2.3.    Payment mechanism and reimbursement tariffs
9.2.4.    Policy considerations by HAS
10.    Reimbursement analysis in Germany
10.1.    Overview of the reimbursement system
10.2.    Reimbursement for extracorporeal membrane oxygenation
10.2.1.    Procedure coding 
10.2.2.    Diagnosis coding
10.2.3.    Payment mechanism and reimbursement tariffs
10.2.4.    Policy considerations by G-BA
11.    Reimbursement analysis in Italy
11.1.    Overview of the reimbursement system
11.2.    Reimbursement for extracorporeal membrane oxygenation
11.2.1.    Procedure coding
11.2.2.    Diagnosis coding
11.2.3.    Payment mechanism and reimbursement tariffs
11.2.4.    Policy considerations
12.    Reimbursement analysis in the Netherlands
12.1.    Overview of the reimbursement system
12.2.    Reimbursement for extracorporeal membrane oxygenation
12.2.1.    Procedure coding 
12.2.2.    Material codes
12.2.3.    Diagnosis coding
12.2.4.    Payment mechanism and reimbursement tariffs
12.2.5.    Policy considerations
13.    Reimbursement analysis in Norway
13.1.    Overview of the reimbursement system
13.2.    Reimbursement for extracorporeal membrane oxygenation
13.2.1.    Procedure coding 
13.2.2.    Diagnosis coding
13.2.3.    Payment mechanism and reimbursement tariffs
13.2.4.    Policy considerations 
14.    Reimbursement analysis in Sweden
14.1.    Overview of the reimbursement system
14.2.    Reimbursement for extracorporeal membrane oxygenation
14.2.1.    Procedure coding 
14.2.2.    Diagnosis coding
14.2.3.    Payment mechanism and reimbursement tariffs
14.2.4.    Policy considerations 
15.    Reimbursement analysis in Switzerland
15.1.    Overview of the reimbursement system
15.2.    Reimbursement for extracorporeal membrane oxygenation
15.2.1.    Procedure coding 
15.2.2.    Diagnosis coding
15.2.3.    Payment mechanism and reimbursement tariffs
15.2.4.    Policy considerations
16.    Disclaimer

18

Jun 2018

The report includes both veno-venous and veno-arterial ECMO applications. Analysis includes the following indications: acute respiratory distress syndrome (VV-ECMO), deterioration of chronic advanced heart failure (VA-ECMO), post-cardiotomy cardiogenic shock (VA-ECMO), post-myocardial infarction cardiogenic shock (VA-ECMO). The analysis covers procedure coding, payment mechanism, reimbursement tariffs and policy restrictions in 11 EU countries including Austria, Belgium, Denmark, England, France, Germany, Italy, the Netherlands, Norway, Sweden and Switzerland.

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