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78 Hyperbaric Oxygenation Therapy KCE Reports 74 6 INTERNATIONAL COMPARISON 6.1 THE NETHERLANDS 6.1.1 Hyperbaric centres The Netherlands had 16.32 million inhabitants in 2005 and an area size of 41 000 km 2 . e In the Netherlands there are 11 hyperbaric centres. They are listed in Table 27. Table 27. Hyperbaric centres in the Netherlands Place Location Max. n° of persons Pressure (bar) Amsterdam AMC 20 2 Bergen op Zoom Hyperbaar Centrum Oosterschelde 4 10 Den Helder Duikmedisch Centrum 8 10 Empel Genie Fort Landmacht 3 5 Hoogeveen Inst. Hyperbare Geneeskunde 12 Maarsseveen Duikcentrum MP 4 6 IJmuiden Wijsmuller 6 6 Rotterdam SmitTak (mobiele tank) 2 6 Rotterdam Inst. Hyperbare Geneeskunde unknown unknown Vlissingen Van den Akker 3 10 Zwijndrecht (NL) Hyperbaar Zuurstof Centrum Rijnmond unknown unknown Source: http://www.b-artcreatives.nl/dive4life/reco.htm (12 December 2007); http://www.ivhg.nl/ 6.1.2 Covered indications According to the CVZ (College Voor Zorgverzekeringen), 135 there is sufficient scientific data and a broad acceptation within the professional group for several indications. For these indications, HBOT is therefore covered by the national insurance package under the specific conditions: • Decompression illness and gas embolism • CO intoxication, in case of decreased consciousness at moment of hospitalization, clinical neurologic, cardiac, pulmonary or psychic symptoms, pregnancy • Soft tissue infections (anaerobic or mixed) as additional treatment to maximum chirurgical therapy: gas gangrene, necrotising fasciitis, anaerobic cellulitis • Crush injuries, compartment syndromes, and other acute traumatic ischemia • Osteoradionecrosis of the mandible, as well as treatment as prevention with implants • Hemorrhagic cystitis after irradiation when conventional therapy is not effective • Radiation proctitis and enteritis • Compromised skin grafts and myocutaneous flaps • Diabetic ulcers in case of insufficiënt result from maximum conventional treatment • Chronic refractory osteomyelitis • Larynx radionecrosis • Re-implantation of fingers/extremities According to the CVZ, there is a lower level of evidence for other indications for which there is only casuistic literature, small series or it concerning rare/serious diseases. e Source : OECD demographic data 2007
KCE Reports 74 Hyperbaric Oxygenation Therapy 79 As for these rare diseases a high level of evidence cannot be expected, the CVZ applies an adjusted evaluation procedure. For these diseases, the CVZ has based its evaluation on the state of research and practice within the international professional group. The CVZ has not evaluated the necessity and effectiveness of the treatment. This needs to be evaluated case by case by the insurer. It concerns the following indications for which the effectiveness of the therapy needs to be evaluated at individual level by the insurer: • Relapse neuroblastoma grade IV • Osteoradionecrosis at other places than the mandible • Radionecrosis soft tissue other than head/neck/pelvic • Surgery and implants of irradiated tissues other than the head/neck area • Pneumatosis intestinalis. 6.1.3 Non-covered indications HBOT is not part of the insured care for the following indications, as there is neither sufficient scientific proof nor a broad acceptation within the professional group: • Acute deafness • Tinnitus • Non-diabetic ulcers, such as decubitus, arteriosclerotic and venous ulcers • Cerebral hypoxia, traumatic or after a stroke • Burns • Ischemic ocular disorders/abnormalities • Radionecrosis of the central nervous system • Multiple sclerosis (based on Cochrane review 2004) • Acute coronary syndrome (based on Cochrane review 2005) • Malign otitis externa (based on Cochrane review 2005) • Acute traumatic brain damage (based on Cochrane review 2004) • Anoxic encephalopathy 6.1.4 Reimbursement level The NZA (Nederlandse Zorg Authoriteit) published the following reimbursement price for treatment with hyperbaric oxygen (declaration code 39995) per session per patient (independent from whether alone or in group) f: • Hospital costs: €160.00 • Fee for specialists: €0.00 For hospitals, this amount is fixed and compulsory. For ZBCs (Zelfstandige Behandelcentra), clinics and independent specialists this is a maximum amount and in practice many insurers only pay about 75% of this maximum (based on expert communication). 6.2 FRANCE 6.2.1 Hyperbaric centres France had a population of 60.87 million people in 2005 on an area of 549 000 km 2 . g There are 23 civil and 4 military centres offering HBOT (Table 28). f Source: http://ctg.bit-ic.nl/Nzatarieven/top.do g Source : OECD demographic data 2007
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