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Table 7b Applications with Partial 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
1005 Visual electrodiagnosis No significant risks identified No rigorous evidence to support diagnostic accuracy Could not be evaluated due to insufficient evidence Funded – well-established tests: -electroretinography; pattern electroretinography; dark adaptometry; electrooculography; visual evoked responses. Not funded – insufficient evidence: – focal electroretinography; multifocal electroretinography; multifocal visual evoked potential; scotopic threshold response; intensity response function. Diagnostic
1006 Endoluminal grafting for abdominal aortic aneurysm Long term could not be established Have not been established No rigorous Australian cost comparison The current MBS items for abdominal aortic aneurysm be restricted to open aortic repair; but endoluminal repair continue to receive public funding under alternative arrangements. Surgical
1018–1020 Hyperbaric oxygen treatment Some risk In some indications Could be cost effective in some indications Funded: – decompression illness, gas gangrene, air or gas embolism; diabetic wounds including diabetic gangrene and diabetic foot ulcers; necrotising soft tissue infections including necrotising fasciitis and Fournier's gangrene, and the prevention and treatment of osteoradionecrosis. Not funded – insufficient evidence: – thermal burns, non-diabetic wounds and decubitus (or pressure) ulcers, necrotizing arachnidism, actinomycosis, soft tissue radionecrosis, osteomyelitis, skin graft survival, multiple sclerosis and cerebral palsy, cardiovascular conditions including acute myocardial infarctions, cerebrovascular disease, and peripheral obstructive arterial disease (POAD), soft tissue injuries including acute ankle sprains and crush injuries, facial paralysis (Bell.s palsy), cluster and migraine headaches, Legg-Calve-Perthes disease (necrosis of the femoral head, especially prevalent in children), sudden deafness and acoustic trauma, Crohn.s disease, osteoporosis, cancer, carbon monoxide poisoning, cyanide poisoning, head trauma, cerebral oedema, acquired brain injury, cognitive impairment, senile dementia, glaucoma, keratoendotheliosis, HIV infection, anaemia from exceptional blood loss, insulin- dependent diabetes mellitus, facial neuritis, arthritis, spinal injuries and non-union of fractures. Therapeutic
1036 Percutaneous transluminal coronary rotational atherectomy for lesions of the coronary arteries Insufficient data Where conventional angioplasty and stenting cannot be undertaken successfully Could not be determined Funding: – revascularisation of complex and heavily calcified coronary artery lesions which cannot be treated by percutaneous transluminal coronary angioplasty (PTCA) alone or when previous PTCA attempts have not been successful; revascularisation of complex and heavily calcified coronary artery stenoses where coronary artery bypass graft (CABG) surgery is contra-indicated. Not funded: – revascularisation of coronary artery stenoses which can be satisfactorily treated by PTCA alone, with or without stent placement; revascularisation of coronary artery in-stent restenoses as a result of prior coronary artery intravascular interventions (since no long-term data exist and short-term data are conflicting). Surgical
1039 Photodynamic therapy with verteporfin for macular degeneration Relatively high and precise number of adverse events More effective than placebo in patients with classic choriodal neovascularisation Modeling suggests a cost per vision year gained of $6,100-$35,400 Funded only for patients with predominantly classic (>50% classic) subfoveal choroidal neovascularisation secondary to MD, a small minority of MD cases. For this sub-group of MD patients, there is some evidence that the therapy may retard the rate of visual loss in the short term. Therapeutic
1052 Radiofrequency ablation of liver tumours No significant differences in complications Statistically significant benefit for RFA over PEI in one RCT More expensive Funded: – percutaneous treatment of non-resectable hepatocellular carcinoma not being considered for surgical resection. Not funded: – insufficient evidence – colorectal metastases (CLM); neuroendocrine liver metastases (NLM). Therapeutic
1056 LeukoScan® Low probability of adverse events Diagnostic accuracy not significantly different Incremental cost is $24,056 and $26,348 LeukoScan is safe and as effective as current methods of WBC scanning, but is more costly. Additional funding is justified for patients who do not have access to ex-vivo WBC scanning. Diagnostic – Radiopharmaceutical
  1. Source: MSAC Reviews http://www7.health.gov.au/msac/msacapps.htm. Accessed 6th Jan'06