INTRODUCTION: In 2020, Chile transitioned from the Bundle Payment (PPV) regime towards DRGs for reimbursement of activities at the tertiary level of healthcare. Since ablation is codified and reimbursed through DRG in Chile, it is not necessary to submit microwave ablation to a Health Technology Assessment for its incorporation but rather to evaluate if its coverage is sustainable.

OBJECTIVES: To analyze if the current reimbursement system (DRG-based) used by the Chilean Public Health Insurance (FONASA) allows sustainable reimbursement of microwave ablation therapy in hepatocellular carcinoma management.

METHODS: A cost study for microwave ablation was carried out to identify the expected average cost level per-patient from the public perspective. For its comparison with the DRG reimbursement, an analysis was carried out through DRG’s variables (payment base, DRG-weight, DRG base-price, risk, expenditure, and quantity) based on publicly accessible national data for 2019 and 2020.

RESULTS: The average cost level per patient by technique was $5,022 USD for laparoscopic, $3,206 USD for percutaneous, and $5,543 USD for open surgery.N= 125 DRG discharges were analyzed, 45.24% (N= 57) reports corresponded to laparoscopic ablation; 40.48% (N=51) were percutaneous, 3.97% (N= 5) open surgery, and 10.32% N= 13) didn’t indicate a specific modality. According to DRG data, the average payment received by a provider for an ablation amounts to $4,386 USD for laparoscopic technique, $5,459 USD for percutaneous, and $9,807 USD for open surgery.

CONCLUSIONS: There are opportunities for open surgery and percutaneous microwave ablation sustainable financing. However, the gap between the average per-patient cost of laparoscopic microwave ablation and DRG reimbursement was $636 USD. Therefore, instruments such as "add-on" DRG payments must be considered to achieve sustainable financing for this surgical technique.