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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