Pressure to save: eye patients must forego proven therapy

Limited vision and blind spots: Anyone suffering from glaucoma can now get help from specialists. But ophthalmologists in Switzerland have been restricted in the treatment of their patients since January 1: they can no longer freely decide on the best treatment for glaucoma (glaucoma). The Federal Office of Public Health (BAG) has determined that minimally invasive glaucoma surgery (MIGS) can no longer be billed to health insurers.

During the procedure, the internal pressure in the eye is lowered and a mini implant is inserted. It is an alternative to eye drops and conventional surgery that, according to experts, works well and does not cause major complications. However, it is more expensive.

The exclusion from compulsory health insurance now means that the therapy is no longer available for many patients. The ophthalmologists show little understanding for the decision. On the one hand, because the BAG decided without consulting the relevant professional associations, which the Swiss Ophthalmological Society (SOG) criticizes.

And secondly, because the “modern and much less traumatic operation” for glaucoma is now reserved for private patients, as an angry ophthalmologist from Central Switzerland writes. So only those who can still afford it.

The BAG will defend the procedure if requested. “The decision to include benefits at the expense of compulsory health insurance rests with the Federal Ministry of the Interior (EDI), not with the BAG,” a spokeswoman wrote.

About the decision she says: Minimally invasive glaucoma surgery was further investigated. The EDI rejected the application to cover the costs because the evidence of effectiveness, suitability and cost-effectiveness was considered insufficient. However, these are mandatory criteria for inclusion in the specialty list, which includes all services subject to mandatory health insurance.

The BAG explains that there are several reasons for not reimbursing the costs. This includes both the inadequate quality of existing scientific studies and the fact that there are no studies on long-term effectiveness. Nowadays it is not possible to assess whether a second operation is necessary and whether complications will occur. This in turn makes it more difficult to assess economic viability.

The ophthalmologists cannot leave it like this. Before Christmas, the Swiss Ophthalmological Society sent a letter of complaint to the BAG. The reasoning remains incomprehensible to them. It is simply wrong that there are no studies proving the benefit of this surgical technique. The BAG’s motivation therefore remains completely unclear.

Rather, it is assumed that there is hope for an austerity effect. This is also incomprehensible to many ophthalmologists. Especially when patients’ eyesight is at stake. The impression of a purely cost decision is apparently fueled by a second rejection. The BAG refused to include a new preparation for lowering the internal pressure in the eye (rhokinase inhibitor) on the list of specialties.

Things are not too bad for the BAG. Reference is made to the possibility of submitting a new application “at any time” for costs to be covered by compulsory health insurance. However, the aspects of missing scientific studies need to be addressed.

The ophthalmologists assess the decision differently: this is “a further infringement of the sovereignty of medical decision-making and goes far beyond the Migs issue as a precedent.” The SOG will take legal action to prevent any restriction of freedom of treatment. (aargauerzeitung.ch)