Transcatheter mitral valve leaflet repair using mitral clips for mitral regurgitation

Series
Mitral valve procedures
Status
Published
Date
Number of report
008

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Report presents summary of the reimbursement situation for a transcatheter mitral valve leaflet repair using mitral clips for mitral regurgitation.

Sample pages are provided for an older version of the report. Before delivery to the client, the report is updated to the current state (e.g., 2022 coding, tariffs, and policy considerations). 

Manufacturers and developers of the technology include:

  • Abbott Vascular (MitraClip)

Report includes essential information about reimbursement and national funding of the transcatheter mitral valve leaflet repair using mitral clips for mitral regurgitation, 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

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

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

4.1.    Overview of the reimbursement system
4.2.    Reimbursement for transcatheter mitral valve leaflet repair using mitral clips
4.2.1.    Payment mechanism and reimbursement tariffs
4.2.2.    Health technology assessment by LBI-HTA
5.    Reimbursement analysis in Belgium
5.1.    Overview of the reimbursement system
5.2.    Reimbursement for transcatheter mitral valve leaflet repair using mitral clips
5.2.1.    Payment mechanism and reimbursement tariffs
5.2.2.    Policy considerations
5.2.2.1.    Reimbursement framework for transcatheter mitral valve leaflet repair using mitral clips   
by INAMI
6.    Reimbursement analysis in Denmark
6.1.    Overview of the reimbursement system
6.2.    Reimbursement for transcatheter mitral valve leaflet repair using mitral clips
6.2.1.    Payment mechanism and reimbursement tariffs
7.    Reimbursement analysis in England
7.1.    Overview of the reimbursement system
7.2.    Reimbursement for transcatheter mitral valve leaflet repair using mitral clips
7.2.1.    Payment mechanism and reimbursement tariffs
7.2.2.    Policy considerations 
7.2.2.1.    National commissioning by NHS England
7.2.2.2.    National commissioning of percutaneous mitral valve leaflet repair for mitral regurgitation by NHS England
7.2.2.3.    Health technology assessment by NICE
8.    Reimbursement analysis in France
8.1.    Overview of the reimbursement system
8.2.    Reimbursement for transcatheter mitral valve leaflet repair using mitral clips
8.2.1.    Procedure coding 
8.2.2.    Diagnosis coding
8.2.3.    Payment mechanism and reimbursement tariffs
8.2.4.    Brand-specific reimbursement for mitral clip system 
8.2.5.    Policy considerations
8.2.6.    Coverage with evidence development
8.2.6.1.    Transcatheter mitral valve leaflet repair using mitral clips for mitral regurgitation
9.    Reimbursement analysis in Germany
9.1.    Overview of the reimbursement system
9.2.    Reimbursement for transcatheter mitral valve leaflet repair using mitral clips
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 Italy
10.1.    Overview of the reimbursement system
10.2.    Reimbursement for transcatheter mitral valve leaflet repair using mitral clips
10.2.1.    Procedure coding at national level
10.2.2.    Procedure coding at regional level (Emilia-Romagna region)
10.2.3.    Diagnosis coding
10.2.4.    Payment mechanism and reimbursement tariffs at national level
10.2.5.    Payment mechanism and reimbursement tariffs at regional level
10.2.6.    Policy considerations
11.    Reimbursement analysis in the Netherlands
11.1.    Overview of the reimbursement system
11.2.    Reimbursement for transcatheter mitral valve leaflet repair using mitral clips
11.2.1.    Procedure coding 
11.2.2.    Material coding
11.2.3.    Diagnosis coding
11.2.4.    Payment mechanism and reimbursement tariffs
11.2.5.    Policy considerations
11.2.6.    Health technology assessment by National Healthcare Institute
12.    Reimbursement analysis in Norway
12.1.    Overview of the reimbursement system
12.2.    Reimbursement for transcatheter mitral valve leaflet repair using mitral clips
12.2.1.    Procedure coding 
12.2.2.    Diagnosis coding
12.2.3.    Payment mechanism and reimbursement tariffs
12.2.4.    Policy considerations 
13.    Reimbursement analysis in Sweden
13.1.    Overview of the reimbursement system
13.2.    Reimbursement for transcatheter mitral valve leaflet repair using mitral clips
13.2.1.    Procedure coding 
13.2.2.    Diagnosis coding
13.2.3.    Payment mechanism and reimbursement tariffs
13.2.4.    Policy considerations 
13.2.4.1.    Recommendations for transcatheter mitral valve leaflet repair using mitral clips in the national clinical guidelines
14.    Reimbursement analysis in Switzerland
14.1.    Overview of the reimbursement system
14.2.    Reimbursement for transcatheter mitral valve leaflet repair using mitral clips
14.2.1.    Procedure coding 
14.2.2.    Diagnosis coding
14.2.3.    Payment mechanism and reimbursement tariffs
14.2.4.    Policy considerations 
14.2.4.1.    Restrictions for percutaneous interventional treatment of severe mitral valve insufficiency in the Health Benefit List
14.2.4.2.    The Swiss Mitraclip Registry
15.    Disclaimer

16

Nov 2022

On October 28, 2022, several Resolutions of the General Directorate of the Common Package of Benefits of the National Health and Pharmacy System were published concerning the use of the system for percutaneous repair of the mitral valve with clip, prioritization of patients with type 2 diabetes mellitus for the provision of glucose monitoring systems, and the use of glucose monitoring system with sensors (flash type) for type 1 diabetes mellitus in childhood and adolescence.

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22

Sep 2022

On September 01, 2022, NHS England published an update of the Specialized Services Policy Pipeline (as of August 24, 2022). Two new MedTech-related Clinical Commissioning Policies were added to the work program (transcatheter edge-to-edge repair of the mitral valve, pectus surgery for really severe pectus), and no new policies were published. The status of ongoing policies was updated as well.

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14

Feb 2022

On January 28, 2022, the Institute for the Hospital Remuneration System (InEK) has published the list of the requests for innovation funding (NUB) that were submitted by the hospitals in 2021. The medical technologies belonging to the cardiovascular, ENT, eHealth, gastrointestinal, neuromodulation, neurovascular, orthopedic, and other technology groups obtained positive status 1.

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09

Dec 2021

In November 2021, the National Institute for Health and Care Excellence (NICE) published two new Interventional Procedure Guidance (percutaneous implantation of pulmonary artery pressure sensors in chronic heart failure and coronary sinus narrowing device implantation for refractory angina), one new Medical Technologies Guidance (Synergo for non-muscle-invasive bladder cancer), one new Diagnostic Guidance (SeHCAT for diagnosing bile acid diarrhea), and four new Medtech Innovation Briefings (clonoSEQ for minimal residual disease, CerebAir for continuous EEG monitoring, 24/7 EEG SubQ for epilepsy, Paige Prostate for prostate cancer). Also, three new clinical guidelines were published, and six were updated.

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16

Nov 2021

In late October 2021, the BfArM (Federal Institute for Drugs and Medical Devices) has published the final version of the 2022 OPS procedure coding classification. The OPS, together with the ICD-10-GM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification), forms the basis for the reimbursement systems in outpatient and inpatient care.

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