OBJECTIVES: Health tourism is a reality. However, clinical excellence is not the only reason for patients wishing to travel for therapy: some reimbursement policies may affect the way patients seek treatment. This study is a first attempt at interpreting patient migration with respect to Vagus Nerve Stimulation (VNS) Therapy for Drug-Resistant Epilepsy in Italy.

METHODS: Based on patient anonymous information obtained from 2017 implantation cards an extraction protocol was created to: (i) map the region of origin of VNS Therapy patients (i.e. the prescribing physician’s region of practice) and the region of implantation and (ii) correlate region of origin and presence/absence of VNS DRE-specific reimbursement. Desk research identified regional policies to provide the information on the availability of medical device reimbursement.

RESULTS: VNS Therapy has been growing rapidly at a rate of 15% per year since 2013. Information from implantation cards was available for 2017. Of the 21 Italian Regional Health Care Authorities, 15 provide at least one implantation center for VNS Therapy (median 2; interquartile range 1-3.5). Seven regions provide VNS DRE-specific reimbursement for VNS Therapy. All procedures on patients treated outside their residence region have a VNS DRE-specific reimbursement. Approximately 66% of all procedures were performed with VNS DRE-specific reimbursement. 20% of the procedures in regions without a VNS DRE-specific reimbursement concerned non-resident patients.

CONCLUSIONS: Most regions are equipped with at least one implanting center, therefore it may not be necessary for patients to travel. VNS DRE-specific reimbursement is available in 7 regions; the national policy ensures the VNS DRE-specific reimbursement for all patients treated outside their residence region. Most of the implanting activity takes place where the circumstances allow for a VNS DRE-specific reimbursement; reimbursement policies may influence the patient flow.