Issues facing the Australian Health Technology Assessment Review of medical technology funding

Abstract

The Australian Health Technology Assessment Review has the potential to have a major effect on the availability of new medical technology and the listing of associated medical procedures on the Medicare Benefits Schedule. Despite this, only about 15% of submissions to the Review came from “medical associations”. Pharmaceutical and medical technologies are inherently different, and there are a number of difficulties associated with evaluating medical technology using the same process and evidence levels as those used for pharmaceuticals. The current sequential and lengthy processing of new medical technology and procedures is delaying access to beneficial medical technology and could be substantially reduced. There is currently no effective funding process for medical technology classified as capital equipment or consumables and disposables. This has created a perverse incentive in favour of using funded implantable prostheses based on access to funding rather than superior clinical effectiveness. The existing horizon scanning process could be better used to not only identify all potentially cost‐effective new and emerging medical technology and procedures as early as possible, but also to identify gaps in the evidence.

Trends and Opportunities in Health Economic Evaluations of Prosthetic Care Innovations

“…O'Malley (2010) indicated that the most common reason for the Australian Medical Services Advisory Committee to not recommend funding for new technology was not only insufficient clinical evidence but also the lack of proven cost-effectiveness presented during early stage of the examination process. 54 …”

“…Promoters can be informed by an abundance of health economic research focusing on a broad range of fundamental and applied HEEs issues that could be more or less relevant (e.g., difference between pharmaceutical and medical technologies). 54 , 58 Some studies provided valuable insights into ways outcomes of HEEs can facilitate the approval process of an innovation by a particular governmental healthcare system (e.g., Australian). 53 , 54 , 59 – 61 Others explained the basic concepts of HEEs to clinicians and prosthetic care providers.…”

“… 54 , 58 Some studies provided valuable insights into ways outcomes of HEEs can facilitate the approval process of an innovation by a particular governmental healthcare system (e.g., Australian). 53 , 54 , 59 – 61 Others explained the basic concepts of HEEs to clinicians and prosthetic care providers. 48 , 56 , 57 Several landmark studies presented prosthetic-specific HEEs.…”

“…Gallego et al (2011) said that earlier CUAs can help to prioritize in which order new technologies are evaluated and allows for the fast-tracking of technologies which either have a least potential for harm or which have a great potential to benefit patients. 54 , 60 …”

Personal journey on appropriate and quality imaging

“…It is more important than ever for us to address the impact of diagnostic imaging on patient management and outcome, even though radiologists have a habit of believing that the advantages of innovative imaging are self‐evident and obvious to all. This is no longer acceptable in the current funding arrangement for new medical technology by Medical Benefit Scheme (MBS) and Medical Service Advisory Committees 11,12 . It took us years to get staging of rectal cancer MRI and oncology PET listed on the MBS despite ample supporting evidence of their clinical effectiveness.…”