Policy Number: SRP 019
Policy Name: Biological Mesh
Status: Individual Prior Approval
Effective Date: 1 April 2024
Next Review Date: 1 April 2026
Biologic and Synthetic Mesh are forms of surgical mesh – loosely woven sheet of either biologic or synthetic materials, used as either a permanent or temporary support for organs and other tissues during surgery.
Biological mesh, including synthetic equivalents, are excluded from National Tariff.
Mid and South Essex ICB will separately fund the use of biological mesh for the following indications whilst it is listed as an exclusion from National Tariff.
- eLAPE reconstructive surgery for low rectal cancer: when used as part of eLAPE (extra-Levator Abdomino Perineal Excision of the rectum) reconstructive surgical technique for low rectal cancer to achieve wound closure where all the following circumstances are met:
– Patient has low rectal cancer with a diagnosis of C19X (rectosigmoid junction) or C20X (rectum)
– Patients with anal cancer diagnosis (C210 or C211) are excluded as NHS England is the responsible commissioner.
– Identified procedure code H331 – Abdominoperineal excision of rectum mapping to HRG FZ08A/B - Breast reconstruction – when used in patients with cancer of the breast, ductal carcinoma in situ and those patients identified with the high risk BRCA gene, for single stage skin sparing mastectomy/reconstruction to avoid the need for a 2-stage operation involving mastectomy and reconstruction.
MSE ICB will not separately fund as an exclusion from National Tariff
- Biological mesh when used for any indication not listed above.
For clarity MSE ICB will not fund use of biologic mesh for complex abdominal wall hernia repair & closure of laparostomy. Given the uncertainties in the literature regarding evidence and circumstances for use, the use of biological mesh in complex abdominal wall hernia repair and closure of laparostomy is not separately funded as tariff exclusion at the current time. - Synthetic equivalents to biological mesh.
- Synthetic mesh* for any indication
* Synthetic mesh does not meet the criteria for consideration as an exclusion from PbR; the costs associated with use are therefore contained within tariff rates for given procedures.
The ICB funds biological mesh when used in funded circumstances and in accordance with the table below:
| Size | Upper cost per single dressing (£) |
|---|---|
| Smaller than 10×10 cm | 500 |
| 10×10 cm | 1200 |
| 10x15cm | 1600 |
| 15-20x20cm | 6000 |
| >20x20cm | 6400 |
Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Further information on applying for funding in exceptional clinical circumstances can be found on the ICB website.
References:
The use of biologic and synthetic mesh/equivalents in surgery Coventry and Warwickshire ICB