New Reimbursement Policy on Costly Treatments for Rehabilitation Care in France: Estimated Impact in a University Hospital

OBJECTIVES: Rehabilitation care (RC) funding in France is under reforming. A reimbursement policy of costly treatments will be introduced in 2023, similarly to acute care (AC). Two drug lists exist: one already available for AC (LA) to which RC will get access and a future one specific to RC (LR), since it has a lower threshold for costliness and specific needs. Listed molecules will be totally covered by the national health insurance in addition to the diagnosis-related group. Hence, a descriptive study of their use was required to assess the financial impact of the reform.

METHODS: The lists’ consumption in 2021 was extracted from Paris University Hospital (AP-HP) (39 facilities) database, globally and for RC units only. Costs are based on contracts’ prices.

RESULTS: In 2021, RC constituted 21k full hospitalisation stays (4% of AC full hospitalisation stays) for 4k beds available (21% of AP-HP). LR+LA molecules represent a cost of €4.8M (0.4% of total drug cost of AP-HP; 54% of RC’s total drug cost).

For RC in 2021, LR amounts to €3.3M, 312k units. Baclofene is the most consumed (63% of total volume), followed by immunosuppressants (11%). Peripheric muscle relaxants are the costliest, mainly botulinum toxin (35% of total cost), followed by anti-anemic preparations (14%).

In complement, molecules among LA used in RC amounts to €1.5M, 3k units. Fidaxomicin is the most consumed (41% of total volume). Other well-consumed classes are anti-haemorrhagics (19%), anti-neoplastics (14%) and systemic anti-mycotics (12%). Anti-haemorrhagics are the costliest (67% of total cost), especially emicizumab (31%).

CONCLUSIONS: The addition of a specific RC list better encompasses chronic treatments. The future reimbursement ensures revenues for AP-HP and broadens the access to costly molecules. National fixed reimbursement rates will be published in 2023 and actual impact shall then be confirmed.