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PRE-COVERAGE ASSESSMENTS OF NEW HOSPITAL INTERVENTIONS ON AUSTRIA: METHODOLOGY AND 3 YEARS OF EXPERIENCE

Published online by Cambridge University Press:  17 April 2012

Philipp Mad ,
Sabine Geiger-Gritsch ,
Gerda Hinterreiter ,
Stefan Mathis-Edenhofer  and
Claudia Wild
Philipp Mad
Affiliation:
Ludwig Boltzmann Institute for Health Technology Assessment email: philipp.mad@hta.lbg.ac.at, philipp.mad@chello.at
Sabine Geiger-Gritsch
Affiliation:
Ludwig Boltzmann Institute for Health Technology Assessment; University for Health Sciences, Medical Informatics and Technology
Gerda Hinterreiter
Affiliation:
Ludwig Boltzmann Institute for Health Technology Assessment
Stefan Mathis-Edenhofer
Affiliation:
Ludwig Boltzmann Institute for Health Technology Assessment
Claudia Wild
Affiliation:
Ludwig Boltzmann Institute for Health Technology Assessment
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Abstract

Objectives: A new decision-making process was set up by the Austrian Ministry of Health to regulate coverage of new proposed Extra Medical Services (EMS; German: Medizinische Einzel-Leistung [MEL]) in 2008. As part of the annual decision-making process an independent academic institution (LBI-HTA) is evaluating relevant evidence on these new technologies and provides HTAs, including evidence-based recommendations for decision makers.

Methods: About ten EMS assessments are performed annually by the LBI-HTA simultaneously between January and March. Each peer-reviewed report consists of a systematic literature review and critical appraisal of evidence using the GRADE methodology. The generation of numerous reports of good quality standards within the short timeframe is achieved by a standardized workflow with predefined assignment of tasks for all participants.

Results: In total, the LBI-HTA performed twenty-five EMS assessments on thirty-three different interventions in the last three years. Coverage was recommended with limitation for eleven (33%) interventions, and not recommended for twenty-two (66%) interventions. The federal health commission decided on acceptance or preliminary acceptance of coverage in seven (22%) cases, rejection in eighteen (55%) cases and changed the status to “subject to approval” in seven (24%) cases.

Conclusions: Pre-coverage assessment of new hospital interventions was implemented successfully in Austria. It has proved to be a useful tool to support decision makers with objective evidence when deciding whether or not to reimburse medical services.

Keywords

Benefit catalogueDRG systemHealth technology assessmentPre-coverage assessment
Type
POLICIES
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 2 , April 2012 , pp. 171 - 179
Copyright
Copyright © Cambridge University Press 2012

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