A riziv/inami-reimbursement proposal for outpatient parenteral antimicrobial therapy (opat) in Belgium
|Outpatient parenteral antimicrobial (or antibiotic) therapy (OPAT) is the parenteral administration of antimicrobial therapy in the outpatient setting (e.g. at home). A way to deliver parenteral therapy in an outpatient setting is by means of non-electronic medication pumps, elastomerics. Although the elastomerics are a convenient and comfortable way to administer OPAT, the elastomeric pumps are not often used in Belgium. This mainly because of the low implementation of OPAT comparing with other countries such as the United States, United Kingdom and The Netherlands. However, the therapy is considered safe, cost-effective and convenient in the international literature To increase the potential of elastomeric pumps in Belgium, Baxter wants to raise the implementation of OPAT in the Belgian hospitals. Therefore, Baxter’s in-company project (ICP)-objective is to develop a RIZIV/INAMI (Rijksinstituut voor ziekte- en invaliditeitsverzekering/ Institut national d'assurance maladie-invalidité)-reimbursement proposal for OPAT. Not only Baxter benefits of the reimbursement of OPAT, also the patient, hospitals, and especially the RIZIV/INAMI, as substantial savings can be achieved on their side. To develop a reimbursement proposal for OPAT, the ideal way in which OPAT can be organized should be identified. Therefore, all stakeholders in the OPAT-ecosystem in Belgium including the patient, caregivers, physicians, hospital, hospital pharmacy, peripheral pharmacy, RIZIV/INAMI, private insurance, pharmaceutical industry and medical technology, home nursing and an external firm Remedus were interviewed. By interviewing these stakeholders, a large variety in the implementation of OPAT in the Belgian hospitals and thus a varying ecosystem is discovered. This is due to the recent implementation of in Belgium and the lack of a clear governmental framework. Every hospital has his own idea and organization of OPAT. Another important issue is the lack of reimbursement of OPAT, making this treatment expensive for the patient in comparison to a regular hospital stay. This mainly due to the ambulatory price of antibiotics and the use of medical materials (including elastomeric pumps) The following three different OPAT-scenarios could be identified in the Belgian hospitals: 1) the firstline scenario, where OPAT is seen as primary care, so the general practitioner and peripheral pharmacy get the responsibility of OPAT after start-up of OPAT in the hospital, 2) the hospital coordinated OPAT, where the hospital keeps control of the treatment and 3) the mixed scenario, where the hospital initially coordinates OPAT, but after a certain period the responsibility is shifted towards the first line care. Based on the interviews with hospitals and the other stakeholders, we concluded that the best current way to organize OPAT in Belgium would be the ‘hospital coordinated OPAT’ scenario. The actual reimbursement proposal consists of four elements. First, the reimbursement proposal includes a compensation of €300 per OPAT-treatment for the organization and coordination of OPAT by the hospitals (OPAT-initiation lump sum). The €300 lump sum is intended to cover the extra costs caused by the initiation of OPAT. Secondly, since there is an immense diversity concerning the antibiotics (much variation in the administration rates, delivery systems and costs of the antibiotics), the reimbursement proposal excludes the antibiotics from a lump sum. We concluded that the ideal way to deliver the antibiotics to the patient is through the hospital pharmacy, so the reimbursement of the antibiotics should be the same for an OPAT-patient as for a patient staying hospitalized. Consequently, the patient should only pay €0.62 co-payment per day independent of the (quantity of) antibiotics used for his/her treatment. Thirdly, as the administration rates of the antibiotics vary a lot and therefore also the medical materials used, five different daily lump sums for the medical materials are developed: three for bolus and intermittent administrations and two for continuous administrations. The former three are: €3.15 per day, €4.90 per day and €6.65 per day, for one, two and three administrations a day, respectively. For the latter, the daily lump sum for one continuous administration equals €32.85 per day, whereas for two administrations this equals €64.30 per day. Fourthly, home nurses should get a compensation dependent on the number of patients visits they have to do in a day. A compensation of €31.19 is provided in case of one and two administrations a day, while a compensation of €46.19 is foreseen when three administrations a day are needed. The financial implications of our reimbursement proposal for some stakeholders could be calculated. Based on a sensitivity-analysis of different parameters such as the changing number of patients, changing variety in antibiotics and changing duration of OPAT, the calculated savings for the RIZIV are around €20 million. The value for the patient is the fact that he/she is not financially penalized anymore while being able to recover in at home setting. Furthermore, the hospitals can receive the OPATinitiation lump sum and part of the money for the medical materials and reimbursement of antibiotics from the RIZIV/INAMI. With the recommended organization of OPAT and the proposed reimbursement, a good foundation for OPAT in Belgium is formed. However, there are some issues we could not address that still need to be solved to obtain an even better implementation of OPAT, such as the insurance of optimal quality and follow-up, involvement of the peripheral pharmacies and acceptance of providing OPAT in retirement homes.
|A riziv/inami-reimbursement proposal for outpatient parenteral antimicrobial therapy (opat) in Belgium
|Special Industries : Healthcare Management
|Van Dyck, Walter