To enhance the quality of coronary artery disease treatments, the National Health Insurance Administration (NHIA) is adding balloon catheters and rotational atherectomy systems in the NHI payment package on December 1, 2023. It is estimated to benefit 10,770 patients a year with approximately 186 million points invested from the NHI budget.
The NHIA stated that coronary arteries are blood vessels that supply blood to the heart muscle. When calcification or plaques narrow the coronary arteries, procedures such as percutaneous transluminal coronary angioplasty or coronary artery stent placement may be performed to open the vessel and keep the vessels from narrowing again. According to statistics, a total of 61,371 percutaneous transluminal coronary angioplasty were performed in 2022 and 80% of which were accompanied by the placement of stents.
In the event of severe calcification of coronary arteries, balloon catheters may not be able to dilate the vessels sufficiently to allow stent placement. Therefore, the NHIA has commissioned the Center for Drug Evaluation, Taiwan, to conduct a health technology assessment. The study showed that the 2021 Guideline for Coronary Artery Revascularization jointly published by the American College of Cardiology, American Heart Association, and Society of Cardiovascular Angiography and Interventions, recommends adopting rotational atherectomy to perform plaque modification for patients with severe calcification or fibrosis to increase the success rate of the intervention. In addition to rotational atherectomy, the guideline also recommends the use of cutting balloons and intracoronary lithotripsy.
To offer more clinically effective treatment options for patients with severe coronary artery calcification within the financial capabilities of the NHI, the NHIA has worked with Taiwan Society of Cardiology and Taiwan Society of Cardiovascular Interventions to continually improve medical safety and healthcare quality for the patients. To achieve the objectives and meet the clinical requirements, the NHIA has expedited the study on including balloon catheters and rotational atherectomy systems in the NHIA package. Finally, the inclusion will take effect on December 1, 2023, as determined by the Pharmaceutical Benefit and Reimbursement Scheme Joint Committee Meeting (for special materials) convened in September 2023. The balloon catheters are expected to benefit around 9,490 patients annually, with an investment of 129 million; and the rotational atherectomy system is anticipated to benefit around 1,280 patients, with an annual investment of 57 million.
Director General Chung-Liang Shih of the NHIA stated that, due to the rapid development of medical technologies, new medical materials are abundant. If a new medical material is clinically proven to effectively benefit the treatment, prevent the deterioration of diseases, improve safety and healthcare quality, and fill the clinical gap, the NHIA, to uphold its purpose of enhancing the health of all citizens, shall continue to include clinically and empirically beneficial new materials necessary for clinical treatments in the NHI payment package. Moreover, the NHIA shall adequately allocate medical resources across different fields to refine healthcare quality and safeguard the health and welfare of all citizens.