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Table 7a Applications with Positive 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

Comment

Type

1002

Oto-acoustic emission audiometry

Only risk – false negative/positive results

Significant variation of results

Not undertaken

The use of this technology appears to allow earlier identification of hearing impairment at less cost than alternative forms of testing.

Diagnostic

1003

OctreoScan¨ scintigraphy for gastro-entero-pancreatic neuroendocrine tumours

Safe

Sensitivity and specificity could not be determined

Not possible due to lack of data

GEP neuroendocrine tumours are relatively rare. Estimates of the incidence of carcinoid tumours vary between 7 and 13 cases per million population per year.

Diagnostic

1007

Saline infusion sonohysterography

Safe

Effective

Cost-effective if resulting in prevention of other service

... as a second-line diagnostic procedure for abnormal uterine bleeding, when findings from transvaginal ultrasound are inconclusive.

Diagnostic

1010

Intravascular extraction of chronically implanted permanent transvenous pacing leads

Complications uncommon

Effective

Insufficient data

It is a much longer, more difficult and skilled procedure than extraction of leads not entrapped by fibrous tissue, which is performed by simple traction without the use of surgical tools. Currently, both procedures are remunerated at the same rate.

Surgical

1016

Samarium153-lexidronam for bone pain due to skeletal metastases

As safe as alternative

Effective

Not done but less costly than alternative

Carcinoma of the prostate or breast – second line treatment

Therapeutic radiopharmaceutical

1021

Hepatitis C viral load testing

Safe

Effective

May be cost-effective if good patient selection

.... only used for patients with confirmed hepatitis C (by ELISA or PCR test) who undertake antiviral therapy. Other restrictions apply.

Diagnostic

1024

Total ear reconstruction

Complication rate high but acceptable

Only one low level evidence trial

Insufficient data

... only a small number of procedures (15 to 20) are therefore expected to be performed each year.

Surgical

1035

Genetic test for Fragile X syndrome

No adverse events reported

Specificity was consistently high

$14,000 – $28,000 per initial case found

Nucleic Acid Amplification (NAA) in those with specific clinical features of Fragile X (A) syndrome, including intellectual disabilities, and in first and second degree relatives of individuals with the Fragile X (A) mutation and Southern Blot where the results of NAA testing are inconclusive.

Diagnostic

1037*

Advanced breast biopsy instrumentation (Note earlier application 1001)

Safety data differs widely

Low level data only

Insufficient evidence

... public funding should be supported for the diagnostic use of this procedure, as long as fees are such that health system costs do not exceed those of comparators.

Diagnostic – Biopsy

1038

Conformal radiotherapy

May result in reduced toxicity

Similar efficacy to comparator

More effective and less costly

.... based on the additional costs of MLC alone, CRT appears to be both more effective and less costly than standard radiotherapy (RT) in some patients groups.

Therapeutic – radiotherapy

1042

Cardiac resynchronisation therapy (CRT)

Appears to be safe

As effective as pharmacotherapy

 

Patients who have moderate to severe chronic heart failure (NYHA class III or IV) despite optimised medical therapy, sinus rhythm, a left ventricular ejection fraction of less than or equal to 35% and a QRS duration greater than or equal to 120ms.

Surgical

1050

Optical Biometry

Safe

Accuracy is statistically superior to that of the commonly used AUS

May be less costly

PCI may be a less costly measurement technique than AUS or IUS and that it offers comparable results to ultrasound techniques.

Diagnostic – Biometry

1061

Implantation of Insertable Loop Recorder for Diagnosis of Recurrent Unexplained Syncope

Unpublished as yet

Unpublished as yet

Unpublished as yet

Patients with recurrent syncope who have had appropriate prior investigations.

Diagnostic

1076

Transurethral microwave thermotherapy (TUMT)

Unpublished as yet

Unpublished as yet

Unpublished as yet

Patients with moderate to severe symptoms of benign prostatic hypertrophy.

Surgical

1077

Sacral nerve stimulation for faecal incontinence

Evidence of safety

Some evidence of effectiveness

Some evidence of cost effectiveness

The total number of patients is small; there is some evidence of effectiveness and cost-effectiveness.

Surgical

  1. Source: MSAC Reviews http://www7.health.gov.au/msac/msacapps.htm . Accessed 6th Jan'06