In accordance with Health Insurance Act (Zvw) and Long-term Care Act (Wlz) the basic package of insured health care includes only health care that fulfills the criteria of “state of science and practice”. It means that basic package is limited to only effective treatment options that were confirmed with sufficient evidence.
In 2009, the Dutch National Health Care Institute (Zorginstituut Nederland, ZIN) published a statement that available evidence for thermal ablation in patients with liver metastases did not meet criteria "the state of science and practice". Then, in 2014 ZIN performed a re-evaluation of evidence for this procedure. Based on this assessment in September of 2017, ZIN prepared a position paper for the thermal ablation procedure. Systematic literature search was performed for within the re-evaluation process. Thus, one RCT and 21 comparative observational studies with performed multivariate analysis or matching prognostic factors were found. No studies have been found for application of thermal ablation in patients with resectable forms of liver metastases.
In conclusion, this position paper supports the statement that thermal ablation can only be considered as the effective treatment of non-resectable colorectal liver metastases in a planned radical operation based on available data from scientific research. Therefore, thermal ablation complies with criteria of "the state of science and practice" and it can be covered by basic health insurance.
Furthermore, ZIN assessed thermal ablation for treatment of resectable liver metastases in accordance with criteria for "the state of science and practice" of methods. ZIN does not support this technology for resectable liver metastases due to insufficient evidence. However, ZIN also performed a review of ongoing studies for resectable and non-resectable liver metastases of colorectal origin. Overall, five ongoing international studies were identified two of them are studies that aimed to evaluate the efficacy of thermal ablation procedure for treatment of resectable liver metastases. Thus, results of ongoing studies will provide additional information for decision-making process in future in relation to the inclusion of this procedure into a basic health insurance package.
See full document in Dutch here.
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