VITAAL
Aortaklepimplantatie
Congres Thoracic Expedition
Onderdeel van de feestelijke bijeenkomst van de Isalaklinieken op 24 januari 2014 is een rapportage over de ervaringen met de TAVI. Dat brengt mij in herinnering dat de TAVI ook inzet is van discussie. Want wie is gebaat met de TAVI?? De TAVI een aortaklepimplantatie via de lies.
TAVI-team Isalaklinieken
Additionele zorgkosten
Wat stond er onlangs in het ESB (Economenblad Jaargang 98 (4674 & 4675) 13 december 2013 en op de BMG website:
“De huidige economische evaluaties van nieuwe medische technologie houden geen rekening met de additionele zorgkosten als gevolg van langer leven. De Nederlandse richtlijnen voor het uitvoeren van economische evaluaties ontraden dit ook. Dit leidt tot onjuiste inschattingen van de welvaartseffecten van nieuwe medische technologie. De richtlijnen zouden daarom moeten worden aangepast”.
Vraag
Hoe is de selectie in Nederland? wat is de rol van de Euroscore?
Euroscore (website)
Kosteneffectiviteitsratio’s
En wat zegt het College voor Zorgverzekeringen (CVZ): Recent is voor een tiental van de bij het CVZ ingediende economische evaluaties (waarbij het ging om behandelingen die leidden tot levensverlenging) onderzocht wat de impact is van het meenemen van de zorgkosten van langer leven op de kosten(effectiviteits) schattingen. Dit is gedaan door in deze studies de zorgkosten in gewonnen levensjaren te schatten met behulp van het instrument PAID, dat resultaten van empirisch onderzoek naar de relatie tussen zorguitgaven en langer leven vertaalt naar cijfers die zijn te gebruiken in KEA’s (Van Baal et al., 2011). Vervolgens zijn nieuwe kosten- en kosteneffectiviteitsschattingen gemaakt, waarbij de zorgkosten van langer leven werden meegenomen. De kosteneffectiviteitsratio’s namen maximaal met 9.000 euro per QALY toe. Om ook specifiek een interventie te bestuderen met een verwachte grote invloed van het meenemen van zorgkosten in gewonnen levensjaren, is de casus Transcatheter aortic-valve implantation (TAVI) nader bezien. De TAVI is een aortaklepimplantatie via de lies. Vanwege het minder invasieve karakter van de interventie kan deze, mogelijk levensreddende behandeling, ook worden toegepast bij oudere patiënten (ongeveer tachtig jaar) bij wie een reguliere hartklepoperatie niet mogelijk is (Eltchaninoff et al., 2008). Juist bij deze patiëntengroep zijn de ongerelateerde medische zorgkosten relatief hoog, ook vanwege het feit dat een deel van deze patiënten geïnstitutionaliseerd is. Het meenemen van deze kosten deed de kosten per QALY stijgen met tussen de 20.000 tot 70.000 euro per QALY. Deze kosten weglaten leidt dus tot een vertekening die niet alleen theoretisch ongerechtvaardigd is maar ook praktisch tot verkeerde besluiten kan leiden.
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