Intensity modulated radiotherapy (IMRT)

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.

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.

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.

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.”

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).

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.

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.

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.

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.

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.”

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

This is an updated version of the National Clinical Guidelines for the Treatment of Brain Metastases published in 2014.

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.

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.

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.

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.

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.

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.

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.