Proton Therapy

Series
Radiotherapy
Status
Published
Date
Number of report
029

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The report presents a summary of reimbursement situation for proton therapy in European countries.      

The analysis covers the application of proton therapy in ocular tumors in adults and pediatric medulloblastoma.

The analysis is provided for the session and out-patient treatment,  including both preparation and delivery of proton therapy. 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 proton therapy include:

  • Hitachi Medical Systems (PROBEAT-RT)
  • IBA (Proteus ONE, Proteus Plus)
  • Mevion (MEVION S250)
  • Sumitomo Heavy Industries (HM series)
  • Varian Medical Systems (ProBeam, ProBeam Compact, ProBeam Multi-Room)

Table of content 

1.    Introduction and summary
2.    Executive summary table
3.    Contents
4.    Abbreviations
5.    What’s new
6.    Methodology
7.    Reimbursement analysis in Austria

7.1.    Overview of the reimbursement system
7.2.    Reimbursement for proton therapy
7.2.1.    Policy considerations
7.2.2.1.    Health technology assessments by LBI-HTA
8.    Reimbursement analysis in Belgium
8.1.    Overview of the reimbursement system
8.2.    Reimbursement for proton therapy
8.2.1.    Procedure coding
8.2.2.    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 proton therapy
9.2.    Reimbursement for intensity modulated radiotherapy
10.    Reimbursement analysis in England
10.1.    Overview of the reimbursement system
10.2.    Reimbursement for proton therapy
10.2.1.    Commissioning of proton therapy 
10.2.2.    Health technology assessments by NICE
11.    Reimbursement analysis in Finland
11.1.    Overview of the reimbursement system
11.2.    Reimbursement for proton therapy
12.    Reimbursement analysis in France
12.1.    Overview of the reimbursement system
12.2.    Reimbursement for proton therapy
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 proton therapy
13.2.1.    Procedure coding 
13.2.2.    Diagnosis coding
13.2.3.    Payment mechanism and reimbursement tariffs
13.2.4.    Policy considerations by G-BA
14.    Reimbursement analysis in Italy
14.1.    Overview of the reimbursement system
14.2.    Reimbursement for proton therapy
14.2.1.    Procedure coding
14.2.2.    Payment mechanism and reimbursement tariffs 
14.2.3.    Policy considerations
15.    Reimbursement analysis in the Netherlands
15.1.    Overview of the reimbursement system
15.2.    Reimbursement for proton therapy
15.2.1.    Procedure coding 
15.2.2.    Payment mechanism and reimbursement tariffs
15.2.3.    Policy considerations by Dutch Healthcare Institute (ZIN)
16.    Reimbursement analysis in Norway
16.1.    Overview of the reimbursement system
16.2.    Reimbursement for proton therapy
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 proton therapy
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 proton therapy
18.2.1.    Procedure coding 
18.2.2.    Diagnosis coding
18.2.3.    Payment mechanism and reimbursement tariffs
18.2.4.    Policy considerations
19.    Summary of procedure codes
20.    Summary of reimbursement codes and tariffs
21.    Disclaimer

09

Mar 2021

On February 24, 2021, NHS England published an update of the Specialized Services Policy Pipeline (covering period November 10, 2020 - February 10, 2021). Two new Clinical Commissioning Policies were added to the work program, and seven new policies were published, including stereotactic ablative radiotherapy, stereotactic radiosurgery and proton therapy. The status of ongoing policies was updated as well.

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05

Feb 2021

In January 2021, the National Institute for Health and Care Excellence (NICE) published two new interventional procedure guidance (self-expanding implant insertion into the intersphincteric space for faecal incontinence and minimally invasive radical hysterectomy for early stage cervical cancer), two new medical technologies guidance (the PLASMA system for transurethral resection and haemostasis of the prostate, and the VAC Veraflo Therapy system for acute infected or chronic wounds), and six Medtech innovation briefings (Optilume for anterior urethral strictures, AI in mammography, AI for analyzing chest CT images, AcQMap for mapping the heart atria to target ablation treatment, and others). Also, two clinical guidelines were updated.

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02

Feb 2021

On January 07, 2021, NHS England published an update of the Specialized Services Policy Pipeline (covering the period October 19, 2020 - December 08, 2020). Two new Clinical Commissioning Policies were added to the work program, and six new policies related to radiotherapy, neurosurgery, pulmonology, and in-vitro diagnostics were published.

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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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23

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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