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Table 7d Applications with Negative Recommendations

From: The Australian experiment: the use of evidence based medicine for the reimbursement of surgical and diagnostic procedures (1998–2004)

App. Description Safety Effectiveness Cost-effectiveness Type
1001 Advanced breast biopsy instrumentation Safe Available evidence does not suggest Not undertaken Diagnostic – biopsy
1004 Transmyocardial laser revascularization Carries risk & adverse events Studies do not demonstrated/sustained effect not proven Savings if effects sustained Therapeutic
1008 Photodynamic therapy for skin and mucosal cancer Safe Trials too small, unproven Not available Therapeutic
1009 Sacral nerve stimulation for urinary incontinence Relatively high adverse event rate Uncertain long term Expensive Surgical
1011 Lung volume reduction surgery – for advanced emphysema Differs widely Limited data – not possible to determine long term Insufficient information Surgical
1012 Vertebral axial decompression therapy for chronic back pain Detailed evidence lacking Some/insufficient No evidence based conclusion can be drawn Therapeutic
1023 Placement of artificial bowel sphincters in the management of faecal incontinence Could not be assessed due to insufficient data Lack of rigorous studies – not demonstrated Could not be assessed Surgical
1028 Gamma knife surgery Lack of data – unproven Uncertain Lack of safety & effectiveness data Surgical
1030 Low intensity ultrasound treatment for the acceleration of bone fracture healing – Exogen\texttrademark bone growth stimulator Safe for adults Trial results contradictory Unfavourable Therapeutic
1032 Intravascular ultrasound Relative safe overall Insufficient evidence Insufficient evidence Diagnostic
1034 Selective Internal Radiation Therapy for hepatic Metastases using SIR-Spheres® Limited evidence Some but insufficient evidence Not possible due to unreliable evidence Therapeutic
1044 Ostase immunoassay for the mass measurement of serum bone alkaline phosphatase No safety risk Insufficient evidence Not performed Diagnostic
1045 Intra-articular viscosupplementation for treatment of osteoarthritis of the knee May be at least as safe as alternatives Limited evidence – as effective as alternatives Little valid information but more expensive Therapeutic
1046 Interstim for sacral nerve stimulation in patients with refractory urinary incontinence Adverse event incidence relatively high Effective but unproven for longer than 12 months Not published Surgical
1047 Endoluminal Gastroplication for the Treatment of Gastro- Oesophageal Reflux Disease (GORD) Limited evidence – more data required May be effective – Limited good quality data Insufficient data Surgical
1048 Intradiscal electrothermal anuloplasty for patients with chronic low back pain due to anular disruption of contained herniated discs Low complications Based on low level evidence Insufficient evidence Surgical
1049 M-VAX TM – a treatment for patients with advanced stage III melanoma Unable to determine due to poorly reported data Not possible to assess due to low level evidence Insufficient data Therapeutic
1053 Placement of artificial bowel sphincters in the management of faecal incontinence Number of safety issues Misleading findings Not possible due to lack of clinical evidence Surgical
1054 Hyperbaric Oxygen Therapy (Resubmission) High rate adverse events Studies flawed – uncertain benefits Not possible Therapeutic
1055 Hysteroscopic sterilisation by tubal cannulation and placement of intrafallopian implants Appears to be relatively safe – short term data Appears to be relatively effective – short term data No evidence Surgical
1059 Endo Venous Laser Treatment for Varicose Veins Safe Insufficient evidence Insufficient evidence Therapeutic
1062 A scan for Imaging Recurrence and/or metastases in patients with histologically demonstrated carcinoma of the colon or rectum Safe Insufficient evidence Insufficient evidence Diagnostic
1067 Genotypic resistance testing of antiretrovirals in HIV Appears to be safe Insufficient evidence Insufficient evidence Diagnostic
1071 Measurement of international normalised ratio (INR) in general practice No excessive safety concerns Limited data Limited to direct costs – uncertainty of effectiveness Diagnostic
1078 Multifocal multichannel objective perimetry (MMOP) Safe Insufficient evidence Could not be determined Diagnostic
1083 Intac Implants   Evidence pertaining to this procedure is immature and small in volume. Lack of published comparative clinical studies does not allow for any cost effectiveness analysis Surgical
  1. Source: MSAC Reviews http://www7.health.gov.au/msac/msacapps.htm. Accessed 6th Jan'06