Cardiovascular Reimbursement Strategy · EU MDR + HTA

CE Mark opens the door.
Reimbursement pays the rent.

The evidence for a Notified Body is not the evidence for CNEDIMTS, G-BA, or NICE. Eclevar designs PMCF programs that satisfy both — from Day 1.

43% The TAVI Gap

Only 43% of CE-marked TAVI devices achieve full EU-wide reimbursement.

Revenue Impact €8M / mo

Average monthly revenue lost for each month of HTA delay.

Time to Decision 18 mo

Average delay between CE Mark and first HTA decision without dual-strategy.

HAS CNEDIMTS
G-BA IQWiG
NICE UK
EUnetHTA JCA 2025
ICER per QALY
The Reimbursement Gap

Most design for CE Mark.
Not for reimbursement.

Notified Bodies assess safety vs state of the art. HTA bodies assess comparative effectiveness vs standard of care with health economic models.

What Notified Bodies assess

Safety and performance. 12-month patency. Freedom from device-related AEs. Annex XIV hierarchy.

What HTA bodies require

Comparative effectiveness. QALY quantification. ICER thresholds. 5-year budget impact. National cost data.

The Eclevar Edge

One protocol. Co-primary endpoints. Design once, get reimbursed everywhere.

Reimbursement Success Rate within 24 Months

🇫🇷 France — HAS/CNEDIMTS (Liste en sus)71%
🇬🇧 UK — NICE MTEP64%
🇩🇪 Germany — G-BA Methodenbewertung48%
🇮🇹 Italy — AGENAS (National)38%
Global Infrastructure

Five HTA Agencies That Matter.

🇫🇷

HAS / CNEDIMTS

France

Two-step process: ASA I-V grading then CEPS pricing. TLR preferred over patency.

🇩🇪

G-BA / IQWiG

Germany

Europe's largest market. Demands MALE composite endpoints. CEC adjudication is mandatory.

🇬🇧

NICE

United Kingdom

Strict ICER threshold (£20-30k/QALY). Pragmatic: accepts RCT-validated endpoints.

🇪🇺

EUnetHTA JCA

European Union

Mandatory from Jan 2025 for Class III and IIb implantables. One common clinical dossier.

Endpoint Architecture

The right endpoint satisfies your NB
and your HTA body simultaneously.

❤️ TAVI & Structural Heart

  • 1

    All-cause mortality (VARC-3)

    Globally standardized. Accepted by all HTA bodies and Notified Bodies.

    HAS · IQWiG · NICE
  • 2

    Freedom from TLR

    Patient-centered outcome. Kaplan-Meier analysis. Explicitly preferred by HAS.

    BIA-Relevant
  • 3

    PRO: EQ-5D-5L

    Non-negotiable for QALY. Recalculated for FR, DE, and UK value sets.

    QALY Calculation

🩺 Peripheral PTA & AVF

  • 1

    Primary Patency + CD-TLR

    Both technical (duplex) and patient-outcome (TLR) endpoints required.

    Annex XIV + HAS
  • 2

    BTK: Limb Salvage

    Amputation-free survival. The MALE equivalent for IQWiG in BTK.

    IQWiG MALE
  • 3

    PRO: VascuQoL

    Validated for peripheral health utility. Essential for functional outcomes.

    VascuQoL Validated
Health Economics

Without a QALY, you cannot
negotiate pricing.

The ICER per QALY is the universal output. Eclevar builds the complete Markov model alongside your clinical program.

Model Deliverables:

• 5-Year Budget Impact Analysis (BIA)

• Monte Carlo Simulations (min. 1,000 for HAS)

• Probabilistic Sensitivity Analysis (PSA)

MARKOV MODEL STATE ENGINE

STATE 1: Post-Procedural Recovery
STATE 2: Well / Functional (QALY Gain)
STATE 3: Event / TLR / Death

Transition probabilities derived from PMCF dataset.

Case Study

TAVI Program: Reimbursement in 14 Months.

Redesigning for France (HAS CNEDIMTS)

A manufacturer had CE Mark but 18 months of failed HAS submissions. Their PMCF used primary patency but lacked TLR data required for reimbursement.

Eclevar Solution: Redesigned protocol mid-program, added TLR co-primary, retrospective DCB comparator arm, and Markov model with French value set.

14 moCE Mark to HAS Decision
ASA IIHAS Grading Achieved
€8M+Annual Revenue Unlocked
Free · 30 Minutes · No Obligation

Your CE Mark evidence
should be your reimbursement dossier.

We review your current PMCF program against HAS, G-BA, and NICE requirements to identify exactly what needs to change to make your evidence reimbursement-ready.

Book Free HTA Assessment

Reforming Clinical Evaluation of Medical Devices in Europe