Cardiac ablation for AF now reimbursed by private insurers

Cardiac ablation procedures for atrial fibrillation will become more accessible following the listing of ablation catheters on the Prostheses List from 1 March 2019.

The move will force private insurers to reimburse the cost of catheters, which cost up to $6000 and have previously been unaffordable for patients even with health cover.

The listing means that around 18,500 patients with AF will be expected to gain access to the devices, freeing up public hospital waiting lists and reducing waiting times for public patients by up to two years, according to federal minister for health Greg Hunt.

A spokesperson for the minister said the listing only affected patients with atrial fibrillation who are treated as a private patient.

“It is expected that the number of patients choosing to undergo cardiac ablation as a treatment option for cardiac ablation may increase by 10%. The predicted cost is approximately $5m per year,” they said.

The Prostheses List has the following restrictions: The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018.  Item 38290 is defined as ABLATION OF ARRHYTHMIA CIRCUITS OR FOCI, or isolation procedure involving both atrial chambers and including curative procedures for atrial fibrillation).

The listing is a win for the Medical Technology Association of Australia (MTAA), which in 2017 successfully lobbied the government to review the exclusion of non-implantable medical devices from the Prostheses List, for which private health insurers are required to pay benefits.

As part of the review, the Medicare Services Advisory Committee (MSAC) assessed the comparative clinical and cost-effectiveness of AF catheter ablation. In November 2018 MSAC advised the minister that catheter ablation for atrial fibrillation (AF) was not cost-effective at the current catheter prices of around $2300 for mapping catheters, $6000 for RF ablation catheters, and $4065 for cryoablation catheters.

Its evaluation report found that  incremental cost-effectiveness ratio (ICER) of the different types of ablation compared with medical therapy at 12 months to be $110,321 per QALY for RF ablation and $95,481 per QALY for cryoablation. Healthcare providers typically cite a willingness-to-pay threshold of $50,000/QALY.

“When the costs of mapping and ablation catheters are assumed to be $500 each (i.e. the total cost of all catheters for each ablation procedure is $1000), the indicative ICER for catheter ablation versus medical therapy is approximately $54,031 per QALY,” the MSAC evaluators noted.

A spokesman for the health minister told the limbic: “Cardiac ablation for the treatment of AF was not deemed to be cost effective at the prices offered by the sponsors at the time. The Department negotiated lower prices with the medical devices industry to enable listing at a cost effective price.”

MBS item reports show a four-fold  increase in claims for item 38290 from 1313 in 2008 to 4065 in 2018 .

The MSAC evaluation attributed this to the increasing number of electrophysiologists improving access to services; and a change in clinical guidelines, which now identify ablation as a first-line treatment for a number of arrhythmias.

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