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EP26.05: Fetal therapies covered by National Health Insurance in Japan
Author(s) -
Sago H.,
Muromoto J.,
Sugibayashi R.,
Ozawa K.,
Wada S.
Publication year - 2019
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.21649
Subject(s) - medicine , hydrothorax , fetal surgery , christian ministry , fetus , surgery , pregnancy , ascites , philosophy , theology , biology , in utero , genetics
Objective: Some fetal therapies are performed as clinical useful treatments, despite other fetal therapies still being considered experimental treatments. Treatment costs being covered by health insurance is important for establishing a therapy as a standard care. We herein report the present state of fetal therapy and our results referenced for consideration of cost coverage by Japan National Health Insurance. Methods:A search was performed to clarify the fetal therapy results referenced for consideration of cost coverage by Japan National Health Insurance. Coverage is determined by the Insurance Medical Council in Ministry of Health, Labour and Welfare in cooperation with the Pharmaceuticals and Medical Devices Agency in Japan. Results:Three fetal therapies are covered by Japan National Health Insurance at present. Fetoscopic laser photocoagulation (FLP) for twintwin transfusion syndrome (TTTS) has been performed in Japan since 2002 and was approved for coverage in April 2012 based on a study showing a 90% survival rate of at least 1 twin among 181 consecutive FLP cases treated between 2002 and 2006. Thoracoamniotic shunting (TAS) for fetal hydrothorax was introduced in the 1990s and was approved in July 2012 based on a prospective onearm trial performed between 2008 and 2010 showing a 71% (12/17) survival rate in hydropic fetuses. Radiofrequency ablation (RFA) for twin reversed arterial perfusion (TRAP) sequence was approved for coverage in March 2019 based on the 85% survival rate of pump twins observed in 40 cases treated between 2002 and 2015. Conclusion: FLP for TTTS, TAS for hydrothorax and RFA for TRAP sequence have been approved for coverage by National Health Insurance due crucially to studies showing good results. Welldesigned studies are required for achieving cost coverage by National Health Insurance. It is important to design good studies when new fetal therapies are introduced in the country. Milestones FLP