043 Fighting overuse of cardiac catheterization by introducing CT-angiography – will it work (this time)? – International perspectives and case study from Germany

<h3></h3> The overutilization of many invasive procedures in Germany, compared to many, if not most, healthcare systems of high-income countries, is well known and well documented. Cardiac catheterization has long been a prominent example of such an overuse of an invasive diagnostic procedure. Although this has been well known for a long time in medical and health policy circles, no measures have been devised or, at least, none had been effective in Germany up to the present. In the post-pandemic healthcare systems, however, it is becoming clear that ‘business as usual’ will not be sustainable due to increasing resource constraints and cannot continue indefinitely. The recent, internationally somewhat late, introduction of coronary CT in Germany into the general benefits catalogue of statutory health insurance, based on a thorough evidence review, serves as a starting point to address the problem. Will it achieve its aims in substituting and thus reducing the number of cardiac catheterizations? – Initially (1.) an overview of utilization figures of diagnostic coronary heart procedures in Germany and internationally, and data on the heterogenous effects the introduction of coronary CT might have caused in different countries (e.g. Denmark, United Kingdom) will give some insights. It will show the international nature of the problem, and that success in catheterization reduction might not be guaranteed. (2.) Feasible policy approaches, some of which are being implemented in Germany (e.g. evidence-based knowledge application/shared decision making, ‘heart teams’, mandatory care pathways, reimbursement rules) will briefly be described using the case study, and their potential efficacy discussed. Based on this, we further suggest to discuss, maybe extended beyond diagnostic heart interventions, (a) why so many diagnostic interventions do facilitate overuse, as they are mostly non-exclusive (one can usually consider alternative or additional tests or images); why (b) the substitution of existing diagnostic approaches might fail – and how appropriate research and technology assessment methods (e.g. looking at entire pathways instead of single technologies) may contribute to success; and (c) which clinical and health system policy options may be most promising to address diagnostics overuse, and – assuming that single approaches may not be sufficiently effective on their own – which systemic policy approaches could be most effective in implementing appropriate health care.