OBJECTIVES: To identify current payment models used for Transcatheter Aortic Valve Implantation (TAVI) and analyze whether these schemes incentivize the adoption of this innovative technology.

METHODS: Information about payment schemes was collected via a standardized questionnaire administered to clinicians, payers, health economists and HTA professionals from nine EU countries. Qualitative analysis of responses was conducted

RESULTS: Findings indicate variations in the payment schemes used for TAVI across different European countries. Some schemes, such as those based on Diagnostic-Related- Groups (DRG), used in countries like Germany, Austria, Italy, Lithuania and the Netherlands, the reimbursement fee usually includes the procedure and the implantable valve. In France and United Kingdom, the cost for TAVI is limited to the procedure only, being the cost of the valve covered by a supplemental payment. In Portugal, TAVI is paid through hospital budget, and, in Spain, payment differs among regions. Identified barriers to the adoption of TAVI include: 1) current payment schemes lack focus on incentivizing the quality and appropriateness of care; 2) DRG-based systems may not suffice to cover the full cost of the technology without incorporating supplemental payments; 3) the lack of distinction in DRG tariff with respect to surgical valve replacement could disincentivize the shift to TAVI; and 4) Bias in the selection of patients, with hospitals favoring those procedures that are more favorable under DRG tariffs, which results in disparities in the TAVI availability. The latter could be mitigated through add-on reimbursement schemes that can effectively support high-cost procedures like TAVI.

CONCLUSIONS: To support the wider extension of TAVI as an innovative technology, payment models should address identified barriers and ensure adequate financial incentives and coverage. Revising current reimbursement schemes could help improve access to innovative technologies.