Robotic surgery interventions

Series
Robotic surgery
Status
Published
Date
Number of report
015

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Report presents summary of reimbursement situation for procedures using robotic equipment in European countries.

Five the most common robotic surgical procedures are included into report:

  • Total prostatectomy for prostate cancer
  • Total nephrectomy for kidney cancer
  • Total hysterectomy for endometrial cancer
  • Anterior resection of rectum for rectal cancer
  • Nissen (total) fundoplication for gastro-esophageal reflux disease (GERD)

Three types of surgical access are considered in the report:

  • Open access
  • Laparoscopic access
  • Robot-assisted access

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

Report focuses solely on reimbursement of robotic-assisted procedures and does not provide information about procurement of robotic equipment.

Reimbursement information is provided for the following geographies:

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

It is also possible to add analysis in Czech Republic, Finland, Hungary, Romania, Russia and Turkey.

Manufacturers of robotic surgery systems include:

  • Auris Surgical Robotics 
  • Corindus Vascular Robotics (CorPath®)                     
  • Elmed medical systems (Avicenna Roboflex™)                
  • Hansen Medical (Magellan™)                                                             
  • Intuitive Surgical (da Vinci®)
  • KB Medical (AQrate™)                                     
  • Mazor Robotics (Renaissance®)                     
  • Medrobotics (Flex®)                               
  • OR Productivity (FreeHand)                                                          
  • Renishaw (neuromate®) 
  • Robocath                                        
  • Smith & Nephew (NAVIO)            
  • Stereotaxis (Epoch®)                                        
  • Stryker (Mako platform)
  • THINK Surgical (TSolution One®)                                  
  • Titan Medical (SPORT™)                                       
  • TransEnterix (SurgiBot™)                                  
  • Verb Surgical                                     
  • Virtual Incision

Table of content

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

5.1.    Overview of the reimbursement system
5.2.    Reimbursement for robotic surgery interventions
5.2.1.    Procedure coding
5.2.1.1.    Procedure coding for total prostatectomy
5.2.1.2.    Procedure coding for total nephrectomy
5.2.1.3.    Procedure coding for total hysterectomy
5.2.1.4.    Procedure coding for resection of rectum
5.2.1.5.    Procedure coding for total fundoplication
5.2.2.    Diagnosis coding
5.2.3.    Payment mechanism and reimbursement tariffs
5.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
5.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
5.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
5.2.3.4.    Reimbursement for resection of rectum in rectal cancer
5.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
5.2.4.    Health technology assessment by LBI-HTA
6.    Reimbursement analysis in Belgium
6.1.    Overview of the reimbursement system
6.2.    Reimbursement for robotic surgery interventions
6.2.1.    Procedure coding 
6.2.1.1.    Coding for total prostatectomy
6.2.1.2.    Coding for total nephrectomy
6.2.1.3.    Coding for total hysterectomy
6.2.1.4.    Coding for resection of rectum
6.2.2.    Payment mechanism and reimbursement tariffs
6.2.2.1.    Reimbursement for total prostatectomy in prostate cancer
6.2.2.2.    Reimbursement for total nephrectomy in kidney cancer
6.2.2.3.    Reimbursement for total hysterectomy in endometrial cancer
6.2.2.4.    Reimbursement for resection of rectum in rectal cancer
6.2.3.    Policy considerations for robotic-assisted total prostatectomy
6.2.3.1.    Health technology assessment by KCE
7.    Reimbursement analysis in Denmark
7.1.    Overview of the reimbursement system
7.2.    Reimbursement for robotic surgery interventions
7.2.1.    Procedure coding 
7.2.1.1.    Procedure coding for total prostatectomy
7.2.1.2.    Procedure coding for total nephrectomy
7.2.1.3.    Procedure coding for total hysterectomy
7.2.1.4.    Procedure coding for resection of rectum
7.2.1.5.    Procedure coding for total fundoplication
7.2.2.    Diagnosis coding
7.2.3.    Payment mechanism and reimbursement tariffs
7.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
7.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
7.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
7.2.3.4.    Reimbursement for resection of rectum in rectal cancer
7.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
8.    Reimbursement analysis in England
8.1.    Overview of the reimbursement system
8.2.    Reimbursement for robotic surgery interventions
8.2.1.    Procedure coding 
8.2.1.1.    Procedure coding for total prostatectomy
8.2.1.2.    Procedure coding for total nephrectomy
8.2.1.3.    Procedure coding for total hysterectomy
8.2.1.4.    Procedure coding for resection of rectum
8.2.1.5.    Procedure coding for total fundoplication
8.2.2.    Diagnosis coding
8.2.3.    Payment mechanism and reimbursement tariffs
8.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
8.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
8.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
8.2.3.4.    Reimbursement for resection of rectum in rectal cancer
8.2.4.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
8.2.5.    Policy considerations 
8.2.5.1.    National commissioning by NHS England
8.2.5.1.1.    Commissioning of robotic-assisted prostatectomy
8.2.5.1.2.    Commissioning of robotic-assisted total nephrectomy
8.2.5.1.3.    Commissioning of robotic-assisted total hysterectomy
8.2.5.1.4.    Commissioning of robotic-assisted resection of rectum with anastomosis
8.2.5.2.    Health technology assessment by NICE
9.    Reimbursement analysis in France
9.1.    Overview of the reimbursement system
9.2.    Reimbursement for robotic surgery interventions
9.2.1.    Procedure coding 
9.2.1.1.    Procedure coding for total prostatectomy
9.2.1.2.    Procedure coding for total nephrectomy
9.2.1.3.    Procedure coding for total hysterectomy
9.2.1.4.    Procedure coding for resection of rectum
9.2.2.    Diagnosis coding
9.2.3.    Payment mechanism and reimbursement tariffs
9.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
9.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
9.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
9.2.3.4.    Reimbursement for resection of rectum in rectal cancer
9.2.4.    Policy considerations
9.2.4.1.    Health technology assessment of total robot-assisted prostatectomy by HAS
9.2.4.2.    Coverage with evidence development
10.    Reimbursement analysis in Germany
10.1.    Overview of the reimbursement system
10.2.    Reimbursement for robotic surgery interventions
10.2.1.    Procedure coding 
10.2.1.1.    Procedure coding for total prostatectomy
10.2.1.2.    Procedure coding for total nephrectomy
10.2.1.3.    Procedure coding for total hysterectomy
10.2.1.4.    Procedure coding for resection of rectum
10.2.2.    Procedure coding for total fundoplication
10.2.3.    Diagnosis coding
10.2.4.    Payment mechanism and reimbursement tariffs
10.2.4.1.    Reimbursement for total prostatectomy in prostate cancer
10.2.4.2.    Reimbursement for total nephrectomy in kidney cancer
10.2.4.3.    Reimbursement for total hysterectomy in endometrial cancer
10.2.4.4.    Reimbursement for resection of rectum in rectal cancer
10.2.4.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
11.    Reimbursement analysis in Italy
11.1.    Overview of the reimbursement system
11.2.    Reimbursement for robotic surgery interventions
11.2.1.    Procedure coding 
11.2.1.1.    Procedure coding for total prostatectomy
11.2.1.2.    Procedure coding for total nephrectomy
11.2.1.3.    Procedure coding for total hysterectomy
11.2.1.4.    Procedure coding for resection of rectum
11.2.1.5.    Procedure coding for total fundoplication
11.2.2.    Diagnosis coding
11.2.3.    Payment mechanism and reimbursement tariffs at national level
11.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
11.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
11.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
11.2.3.4.    Reimbursement for resection of rectum in rectal cancer
11.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
12.    Reimbursement analysis in the Netherlands
12.1.    Overview of the reimbursement system
12.2.    Reimbursement for robotic surgery interventions
12.2.1.    Procedure coding 
12.2.1.1.    Procedure coding for total prostatectomy
12.2.1.2.    Procedure coding for total nephrectomy
12.2.1.3.    Procedure coding for total hysterectomy
12.2.1.4.    Procedure coding for resection of rectum
12.2.1.5.    Procedure coding for total fundoplication
12.2.2.    Diagnosis coding
12.2.3.    Payment mechanism and reimbursement tariffs
12.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
12.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
12.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
12.2.3.4.    Reimbursement for resection of rectum in rectal cancer
12.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
12.2.4.    Policy considerations
12.2.5.    Health technology assessment by National Healthcare Institute
13.    Reimbursement analysis in Norway
13.1.    Overview of the reimbursement system
13.2.    Reimbursement for mitral robotic surgery interventions
13.2.1.    Procedure coding
13.2.1.1.    Procedure coding for total prostatectomy
13.2.1.2.    Procedure coding for total nephrectomy
13.2.1.3.    Procedure coding for total hysterectomy
13.2.1.4.    Procedure coding for resection of rectum
13.2.1.5.    Procedure coding for total fundoplication 
13.2.2.    Diagnosis coding
13.2.3.    Payment mechanism and reimbursement tariffs
13.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
13.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
13.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
13.2.3.4.    Reimbursement for resection of rectum in rectal cancer
13.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
13.2.4.    Policy considerations 
13.2.4.1.    Review of evidence for robot-assisted prostatectomy by NOKC
14.    Reimbursement analysis in Sweden
14.1.    Overview of the reimbursement system
14.2.    Reimbursement for robotic surgery interventions
14.2.1.    Procedure coding 
14.2.1.1.    Procedure coding for total prostatectomy
14.2.1.2.    Procedure coding for total nephrectomy
14.2.1.3.    Procedure coding for total hysterectomy
14.2.1.4.    Procedure coding for resection of rectum
14.2.1.5.    Procedure coding for total fundoplication
14.2.2.    Diagnosis coding
14.2.3.    Payment mechanism and reimbursement tariffs
14.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
14.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
14.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
14.2.3.4.    Reimbursement for resection of rectum in rectal cancer
14.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
14.2.4.    Policy considerations 
14.2.4.1.    Recommendations for radical prostatectomy in the national clinical guidelines
14.2.4.2.    Recommendations for resection of rectum in the national clinical guidelines
15.    Reimbursement analysis in Switzerland
15.1.    Overview of the reimbursement system
15.2.    Reimbursement for robotic surgery interventions
15.2.1.    Procedure coding 
15.2.1.1.    Procedure coding for total prostatectomy
15.2.1.2.    Procedure coding for total nephrectomy
15.2.1.3.    Procedure coding for total hysterectomy
15.2.1.4.    Procedure coding for resection of rectum
15.2.1.5.    Procedure coding for total fundoplication
15.2.2.    Diagnosis coding
15.2.3.    Payment mechanism and reimbursement tariffs
15.2.3.1.    Reimbursement for total prostatectomy in prostate cancer
15.2.3.2.    Reimbursement for total nephrectomy in kidney cancer
15.2.3.3.    Reimbursement for total hysterectomy in endometrial cancer
15.2.3.4.    Reimbursement for resection of rectum in rectal cancer
15.2.3.5.    Reimbursement for total fundoplication in gastro-oesophageal reflux disease
15.2.4.    Policy considerations 
16.    Disclaimer

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19

Feb 2021

In February 2021, Healthcare Improvement Scotland released a review of recently published evidence to inform the National Planning Robotic Review Group on the impact of the number of robotic-assisted procedures (gynecological, colorectal, urological) per treatment center/surgeon on the outcomes achieved and any related evidence on the learning curves for these procedures.

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31

Jan 2020

Norway established in 2013 a framework “New Method” for the introduction of innovations into the health care system through either a national or hospital-based health technology assessment. In this framework, all innovations should undergo HTA before being funded. In January 2020, four new mini-HTA projects of medical technologies were launched in Norway: robotic-assisted procedures, ear reconstruction, continuous electroencephalography, among others.

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06

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 robotic surgery technologies. This post provides some key facts about the HTA, funding and innovation payment landscape for robotic surgery devices in Europe.

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