Table 7d Applications with Negative Recommendations
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 |