TAVI now covered by health insurance in South Korea - Low-risk groups to maintain 80% self-payment rate

TAVI now covered by health insurance in South Korea - Low-risk groups to maintain 80% self-payment rate

Starting from May, Transcatheter Aortic Valve Implantation (TAVI) will be covered by health insurance for patients who are not suitable for surgery or are high-risk groups. However, depending on the risk group, the self-payment rate will be set at 50% for intermediate-risk groups and 80% for low-risk groups.

Previously, discussions were held to adjust the self-payment rate from 80% to 50% for patients who do not meet the criteria, but it was ultimately decided to maintain the current system.

In addition, for some indications, the self-payment rate for Non-stent Aortic Valve Replacement Surgery will be partially covered under the current selective payment system, while the remaining selective payment rate will be maintained at 50%.

Starting from May 2022, TAVI will be covered by health insurance for patients who meet the criteria, and the current selective payment rate of 80% self-payment will be applied. The Ministry of Health and Welfare discussed and approved changes to the health insurance standards for the above procedures at the 7th Health Insurance Policy Deliberation Committee on the 31st of the same month.

The subjects of selective payment deliberation were four items, including Transcatheter Aortic Valve Implantation, Non-stent Aortic Valve Replacement Surgery, NK Cell Activity Test (Precision Immunology Test), and Blood Flow Therapy using Polymyxin B Fixed Fibers.

As a result of the committee's deliberation, TAVI will be covered by health insurance for some indications, such as patients who are not suitable for surgery or are high-risk groups. However, intermediate-risk and low-risk groups will maintain the selective payment rates of 50% and 80%, respectively.

TAVI is a procedure that involves inserting an artificial valve instead of removing the diseased valve in patients with severe aortic stenosis.

Under the current standards, selective payment rates of 80% self-payment have been applied to patients who are not suitable for surgery or are high-risk groups. However, coverage will now be extended to some indications.

During the suitability evaluation, it was considered that patients who are not suitable for surgery or are high-risk groups (STS score>8%) are highly recommended in major countries' treatment guidelines. Additionally, the decision was made based on the proven effectiveness of TAVI compared to other procedures in terms of mortality and complications, and it is not easy to replace it with surgery.

Furthermore, even if the risk of surgery is not high, the elderly are increasingly being recommended for TAVI procedures (over 80 years old in the United States and over 75 years old in Europe) due to their increasing life expectancy (83.5 years in South Korea). For this reason, it is necessary to consider the benefits of TAVI for patients over 80 years old who are at high risk for surgery.