On September 30, 2020, the Dutch Healthcare Institute (Zorginstituut Nederland, ZIN) published the position that transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis and a high risk of surgery is eligible for reimbursement under basic health insurance package.
The ZIN position is based on the results of two randomized studies, in which TAVI has been compared with surgical aortic valve replacement (SAVR) in patients with aortic stenosis and a high risk of surgery. Patients were followed for up to 5 years after surgery. The ZIN concluded that for the patient group with a high surgical risk eligible for transfemoral TAVI, the procedure meets the criteria of the “state of science and practice” and can be reimbursed for this group of patients under the basic insurance package.
In patients with symptomatic severe aortic stenosis and low or moderate surgical risk, there is great uncertainty about the medium and long-term effects. That is why TAVI does not meet the criteria of the “state of science and practice” in this group of patients and is therefore not reimbursed under the basic insurance package.
In order to promote appropriate use in practice, the Dutch Association of Cardiologists and the Dutch Association for Thoracic Surgery, in collaboration with ZIN, have developed a guide for the identification of high-risk patients.
Treatment with TAVI is more expensive than SAVR, and that is why agreements about purchasing and lowering the maximum tariffs for the reimbursement of TAVI have been made in consultation with health insurers and the Dutch Healthcare Authority (NZa).
The full details in Dutch can be found here.
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