Favorable Reimbursement Scenario for Transcatheter Heart Valve Surgery
“Increasing insurance coverage for transcatheter heart valve surgery across the globe is likely to bolster its adoption,” says RNCOS
The Transcatheter Heart Valve is a fairly expensive device, with the average cost ranging from US$ 25,000–US$ 35,000. Due to this, reimbursement is a very important criterion for the growth of this market. According to report published by RNCOS, named, “Global Transcatheter Market Outlook 2020”, the improving reimbursement scenario across the globe is a major reason for increasing adoption of transcatheter heart valves.
In this regard, the Center for Medicare and Medicaid Services (CMS) formally approved to provide insurance for transcatheter heart valve replacement procedures in 2012, only if certain conditions are fulfilled. These include using a valve and implantation system that has received pre-market approval from the FDA; pre examination of the patients by two cardiac surgeons independently face-to-face; the presence of the patient – both before and after the operation – under the care of a heart team.
The reimbursement practice currently varies across countries in Europe. Germany, due to a lack of center restrictions and the high insurance payment, is the country with the largest number of TAVR procedures, followed by France.
Also, Japan’s Central Social Insurance Medical Council (Chuikyo), approved to provide reimbursement for the transcatheter aortic valve, which was approved for use in 2013. The Japanese Social Insurance council has approved reimbursement of approximately US$ 46,000. This approved reimbursement covers the cost of the device as well as taxes, certain hospital fees and distribution expenses.
The availability of insurance coverage for the transcatheter heart valves is one of the major factors responsible for driving the market.
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