Inquiry to the Federal Council

HTA procedure concerning iron therapy / inquiry to the Federal Council by SIHO, 4.10.18

Dear Federal Councillor Berset

Since 2015, the Federal Council has been implementing a so-called HTA regarding iron therapy. HTA can be understood as an assessment of a treatment method. More specifically it is the assessment of the quality of a treatment method. However, the word HTA does not imply on what basis such an assessment should be made. In Switzerland, the so-called WZW criteria are available as the basis for such an assessment (effectiveness, expediency, economic efficiency). For example, the Federal Council, the FMH and the medical officers have expressed this opinion. In Switzerland, a treatment method is considered to be covered by health insurance depending if the WZW criteria are met (KVG, Art. 32).

The previous correspondence regarding HTA between the BAG and the Swiss Iron Health Organization SIHO can be viewed on the Iron Blog.

In 2018, the BAG decided to ignore the evaluation of effectiveness and expediency of iron-HTA and to consider only economic efficiency. WZW was turned into W. From SIHO’s point of view, the Swiss government is no longer in a position to decide on the health insurance coverage of iron therapy. Irrespective of this, the BAG has publicly announced that it intends to decide on the health insurance coverage of iron therapies in the foreseeable future. Thus, for the patients, mainly women, the specific question arises: Should the intravenous iron therapy which was successfully introduced in Switzerland in 1998 continue to be paid by the health insurance companies? Or should women in the future be sentenced to pay for the iron therapy necessary as a result of their menstruation? The Swiss government is facing an important decision that directly affects hundreds of thousands of patients.

We would like to ask you politely if, from your point of view, the obligation to pay for a therapeutic method continues to depend on the fulfillment of the WZW criteria, as demanded by the Federal Council, the FMH, the Swiss medical officers and the Health Insurance Act (KVG). Or should the Federal Council now be authorized to decide on health insurance coverage without knowing the WZW criteria?

There is another question to be answered. In Switzerland, an HTA for iron therapy has already taken place, taking into account the WZW criteria, in October 2014 by the Swiss Medical Board. At that time it was clearly demonstrated that treatment with iron infusions makes sense in cases of severe iron deficiency even without anemia. Regardless of this, why does the BAG conduct a second HTA procedure for iron therapy since 2015, this time even without considering the WZW criteria?

Best regards

Dr. med. Beat Schaub, President SIHO          Dr. med. Bruno Büchel, Vice President SIHO