Development of coverage with evidence development for medical technologies in Switzerland from 1996 to 2012

Abstract

Objectives: The aim of this study was to assess incidence, time frame, and outcome of Coverage with Evidence Development (CED) decisions in the Swiss Basic Health Insurance scheme. Methods: Analysis of all controversial medical technologies submitted to review by the Swiss Federal Office of Public Health (FOPH) from 1996 to 2012 with focus on decisions with constraints. Description of types of technology, type of initial decision, duration of evaluation period, final decision, and search for potential factors associated with changes over time. Results: Forty-five (37.5 percent) of 120 controversial health technologies were classified as yes, in evaluation, reimbursed for a certain period of time and thirty-five (29.2 percent) as no, in evaluation, not reimbursed by the Federal Department of Home Affairs from 1996 to 2012. The rate of CED decisions ranged between zero and nine per year and was influenced by type of technology and calendar year. Forty-four of forty-five decisions were subject to further restrictions, to a center or a specialist (76 percent), indications (49 percent), registry (31 percent), or other (49 percent). The time to a final decision ranged from 1.5 to 11 years (median, 6 years). No factors associated with initial decision and final outcome could be identified. Conclusions: CED as a reality in Switzerland might have enabled patients to obtain access to promising technologies early in their life cycle. CED might have acted as a trigger to a successful implementation of a comprehensive national registry. The lack of qualitative data stresses the urgent need for evaluation of the HTA decisions and their impact on patient outcome and costs.