Intensity modulated radiotherapy (IMRT)
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The report presents a summary of reimbursement situation for Intensity modulated radiotherapy (IMRT) in European countries.
The analysis covers the application of IMRT.
The analysis is provided for the session and out-patient treatment, including both preparation and delivery of IMRT. The only reimbursement within public / statutory health insurance systems is considered.
The report includes essential information about reimbursement, including:
- Brief country-specific overview of reimbursement system
- Procedure coding for technology
- Diagnosis coding
- Payment mechanism for technology
- Reimbursement tariffs for technology
- Restrictions on indications or scenarios for the 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)
- Finland
- France
- Germany
- Italy
- The Netherlands
- Norway
- Sweden
- Switzerland
It is also possible to add analysis in Czech Republic, Finland, Hungary, Romania, Russia and Turkey.
Manufacturers of equipment for intensity modulated radiotherapy include:
- Accuray (Radixact)
- Elekta (Precise Treatment System)
- Neusoft (NMSR600 - NeuLife)
- Shinva Medical (XHA600D)
- Varian Medical Systems (Halcyon, VitalBeam, Trilogy)
Table of content
1. Introduction and summary
2. Executive summary table
3. Contents
4. Abbreviations
5. Methodology
6. What’s new
7. Reimbursement analysis in Austria
7.1. Overview of the reimbursement system
7.2. Reimbursement for intensity modulated radiotherapy
7.2.1. Procedure coding
7.2.2. Diagnosis coding
7.2.3. Payment mechanism and reimbursement tariffs
7.2.4. Health technology assessments by LBI-HTA
8. Reimbursement analysis in Belgium
8.1. Overview of the reimbursement system
8.2. Reimbursement for intensity modulated radiotherapy
8.2.1. Procedure coding
8.2.2. Payment mechanism and reimbursement tariffs
8.2.3. Policy considerations by the INAMI/RIZIV
8.2.3.1. Health technology assessments by KCE
9. Reimbursement analysis in Denmark
9.1. Overview of the reimbursement system
9.2. Reimbursement for intensity modulated radiotherapy
9.2.1. Procedure coding
9.2.2. Diagnosis coding
9.2.3. Payment mechanism and reimbursement tariffs
9.2.4. Policy considerations
10. Reimbursement analysis in England
10.1. Overview of the reimbursement system
10.2. Reimbursement for intensity modulated radiotherapy
10.2.1. Procedure coding
10.2.2. Payment mechanism and reimbursement tariffs
10.2.3. Policy considerations
10.2.3.1. Specifics of commissioning of the procedure
10.2.3.2. Health technology assessments by NICE
11. Reimbursement analysis in Finland
11.1. Overview of the reimbursement system
11.2. Reimbursement for intensity modulated radiotherapy
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 France
12.1. Overview of the reimbursement system
12.2. Reimbursement for intensity modulated radiotherapy
12.2.1. Procedure coding
12.2.2. Diagnosis coding
12.2.3. Payment mechanism and reimbursement tariffs
12.2.4. Policy considerations by HAS
13. Reimbursement analysis in Germany
13.1. Overview of the reimbursement system
13.2. Reimbursement for intensity modulated radiotherapy
13.2.1. Procedure coding
13.2.2. Payment mechanism and reimbursement tariffs
13.2.3. Policy considerations by G-BA
14. Reimbursement analysis in Italy
14.1. Overview of the reimbursement system
14.2. Reimbursement for intensity modulated radiotherapy
14.2.1. Procedure coding at national level
14.2.2. Procedure coding at regional level (Emilia-Romagna, Lombardy, Veneto regions)
14.2.3. Payment mechanism and reimbursement tariffs at national level
14.2.4. Payment mechanism and reimbursement tariffs at regional level
14.2.5. Policy considerations
15. Reimbursement analysis in the Netherlands
15.1. Overview of the reimbursement system
15.2. Reimbursement for intensity modulated radiotherapy
15.2.1. Procedure coding
15.2.2. Diagnosis coding
15.2.3. Payment mechanism and reimbursement tariffs
15.2.4. Policy considerations by Dutch Healthcare Institute (ZIN)
16. Reimbursement analysis in Norway
16.1. Overview of the reimbursement system
16.2. Reimbursement for intensity modulated radiotherapy
16.2.1. Procedure coding
16.2.2. Diagnosis coding
16.2.3. Payment mechanism and reimbursement tariffs
16.2.4. Policy considerations
17. Reimbursement analysis in Sweden
17.1. Overview of the reimbursement system
17.2. Reimbursement for intensity modulated radiotherapy
17.2.1. Procedure coding
17.2.2. Diagnosis coding
17.2.3. Payment mechanism and reimbursement tariffs
17.2.4. Policy considerations
18. Reimbursement analysis in Switzerland
18.1. Overview of the reimbursement system
18.2. Reimbursement for intensity modulated radiotherapy
18.2.1. Procedure coding
18.2.2. Payment mechanism and reimbursement tariffs
18.2.3. Policy considerations
19. Summary of procedure codes
20. Summary of reimbursement codes and tariffs
21. Disclaimer
13
Jan 2021
The revised EBM (German Uniform Evaluation Standard) catalog came into force on January 1, 2021. The most significant changes include the increase of the reimbursement base rate and the introduction of many new surcharge fees in the area of radiotherapy services.
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Dec 2020
In November 2020, the General Directorate of Basic Package of National Health System and Pharmacy Services published the Resolution on the agreement of the Commission of Benefits, Insurance, And Financing in relation to the proton therapy technique. The key points of the agreement include the recommendation for the creation of an interdisciplinary committee in each autonomous community to evaluate each specific case of proton therapy and therapeutic indications.
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Oct 2020
At the information meeting on October 13, 2020, Norwegian Directorate for e-Health presented planned changes in the coding system (NCSP-NCMP-NCRP) for 2021. Two new surgical procedure codes for laparoscopy, two new radiology procedure codes, and nine new medical procedure codes are proposed.
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Aug 2020
In July 2020, the network of European HTA agencies, EUnetHTA, announced a final project plan of the project OTCA25 “Stereotactic Body Radiation Therapy (SBRT) for lung, prostate, and liver cancer.”
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Jul 2020
A new guideline on follicular lymphoma (FL) has been published as part of the oncology guideline program. The guideline was developed by 64 experts from 21 specialist societies and organizations under the supervision of the German Society for Hematology and Medical Oncology (DGHO).
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Jul 2020
On June 16, 2020, HTA Austria – Austrian Institute for Health Technology Assessment (AIHTA), issued an updated report on the indications for proton and carbon ion therapy with an overview of confirmed indications, indications that are only recommended under clinical research, and excluded indications.
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Jul 2020
In June 2020, NHS England announced that it is accelerating the use of stereotactic ablative radiotherapy (SABR) requiring fewer doses than standard radiotherapy, decreasing the number of hospital visits that potentially vulnerable patients need to undergo. It will now be available through the NHS by the end of the current financial year, rather than full rollout by 2022.
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May 2020
In April 2020, the Belgian National Institute for Health and Disability Insurance (INAMI-RIZIV) introduced four new nomenclature codes for stereotactic radiotherapy (Belgian Monitor of April 27, 2020). Physicians also must register data on provided stereotactic radiotherapy series in the specific module of Cancer Registry Foundation.
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Apr 2020
The report presents a summary of the reimbursement situation for minimally invasive treatment of prostate cancer in Europe. The following procedures are considered under the scope of analysis: high intensity focused ultrasound (HIFU), cryoablation, focal laser ablation, radiofrequency ablation, microwave thermal ablation of the prostate. Open and laparoscopic radical prostatectomy, as well as external radioation therapy and low-dose-rate barchytherapy, are considered as comparators. 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. It is also possible to add analysis in the Czech Republic, Finland, Hungary, Romania, Russia and Turkey.
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Dec 2019
In late November 2019, the network of European HTA agencies, EUnetHTA, announced the final plan of the project OTCA23 “Biodegradable rectum spacers to reduce toxicity for prostate cancer.”
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Nov 2019
MTRC has developed three reports on the key market access topics, including innovation funding, health technology assessment and funding frameworks for medical devices. These reports help to understand the relevance of these frameworks to certain types of medical technologies, including radiotherapy technologies. This post provides some key facts about the HTA, funding and innovation payment landscape for radiotherapy devices in Europe.
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Oct 2019
In August 2019, the Norwegian Institute of Public Health has released an HTA report regarding the effectiveness of treatment for localized prostate cancer commissioned by the Centre for joint decision-making to summarize the findings regarding this method. The effectiveness of the several treatment methods is unknown due to the lack of evidence. There is little or no difference in survival after radical prostatectomy compared to low-dose-rate brachytherapy.
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Aug 2019
The HTA center of Swedish Västra Götaland region has published a report for the impact of postmastectomy radiotherapy (PMRT) on complications and results of immediate breast reconstruction (IBR). PMRT compared with no radiotherapy (RT) results in a clinically significant increase of implant or tissue expander loss in patients undergoing IBR with moderate certainty of evidence. Other findings (decrease in patient satisfaction, an increase of re-operations or capsular contracture rate increase) gained low certainty of evidence.
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Mar 2019
On the Interterritorial Council that took place March 4th, 2019, the Working Plan for the Spanish Network for Health Technology Assessment was agreed and published. The working plan includes 22 health technology assessment reports, 7 monitoring studies, 9 clinical practice guidelines, and 1 evidence-based product.
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Feb 2019
In early February 2019, the entity that performs health technology assessment for medical devices in Italy, AGENAS, has called for the voluntary contribution of the clinical experts and/or reviewers, as well as for the participation of the manufacturers for announced that they’re working on several HTA projects on different medical devices and procedures, including bariatric surgery, continuous glucose monitoring, Elecsys®sFlt-1/PlGF test and others.
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Feb 2019
The Clinical Coding and Schedule Development (CCSD) group develop and maintains procedural and diagnostics nomenclature for private payers in England. New procedure codes concern robotic-assisted laparoscopic procedures, 2-dimensional radiotherapy, revision of anti-reflux operations, etc. The codes are introduced with a recommended adoption date being the 1st of May 2019. The document also contains a list of textual changes in codes and an updated list of unacceptable combinations of codes.
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Oct 2018
In mid-August 2018, the Austrian HTA body, the Ludwig-Boltzmann Institute (LBI), has published a health technology assessment in which they have assessed the efficacy and safety of stereotactic radiotherapy (Cyberknife®), proton beam therapy and irreversible electroporation (Nanoknife®) for localized prostate cancer (PCa). It was concluded, there is inadequate and insufficient evidence to show that three evaluated technologies have either a positive impact on survival and quality of life or the ability to prevent or delay prostatectomy.
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Oct 2018
In mid-August 2018, the Austrian HTA body, the Ludwig-Boltzmann Institute (LBI), has published an evaluation of efficacy and safety of carbon ion beam radiotherapy (CIRT) for twelve oncological indications.
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Jul 2018
In the second half of May, the National Institute for Health and Care Excellence (NICE) published two new interventional procedure guidance for low-level laser therapy for preventing or treating oral mucositis caused by radiotherapy or chemotherapy and endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by cancer.
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Jul 2018
Two mini-method assessments regarding brachytherapy for esophageal cancer and targeted gene deep-sequencing panels were initiated by Oslo University Hospital in May of 2018. All finalized mini-method assessments are published in the National Database for Mini-HTA.
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May 2018
This is an updated version of the National Clinical Guidelines for the Treatment of Brain Metastases published in 2014.
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Apr 2018
Eight reimbursement reports with the total size of 882 pages cover the most common radiotherapy modalities including brachytherapy, 3D conformal radiation therapy, stereotactic radiosurgery, stereotactic body radiation therapy, intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), image-guided radiotherapy, proton therapy. The analysis covers procedure coding, payment mechanism, reimbursement tariffs and policy restrictions in 12 EU countries including Austria, Belgium, Denmark, England, Finland, France, Germany, Italy, the Netherlands, Norway, Sweden and Switzerland.
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Apr 2018
In April 2018, Danish Health Authority published 163 new codes for the Health Care Classification System, including five diagnosis codes, 34 surgical and 29 medical procedure codes. These codes are used to classify procedures in Danish DRG system.
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Mar 2018
The background for updating the National Clinical Guideline for Treatment of Brain Metastases is that local treatment (stereotactic radiation therapy) has gained more space in the treatment of brain metastases.
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Mar 2018
The Clinical Coding and Schedule Development Group develops and maintains procedural and diagnostics nomenclature for private payers in England. In February new codes for preparation and delivery of radiotherapy, knee resurfacing arthroplasty, balloon dilatation of the Eustachian tube and MRI-guided focused ultrasound (MRgFUS) thalamotomy for essential tremor were added to the CCSD Schedule.
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Mar 2018
Interstitial low-dose rate brachytherapy was commissioned to the Institute for Quality and Efficiency in Health Care (IQWiG) by the Federal Joint Committee (G-BA) in order to analyze the current knowledge on procedure.
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Feb 2018
The background for updating the National Clinical Guideline for Treatment of Brain Metastases is that local treatment (stereotactic radiation therapy) has gained more space in the treatment of brain metastases.
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Jan 2018
The Department of Home Affairs (EDI) in Switzerland decided upon the coverage with evidence development (CED) of two types of positron emission tomography as well as stereotactic radiotherapy (photons) of exudative age-related macular degeneration. The status is given to contested medical services for a specific period which is extended until evidence is complete.
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