Department of Health Update:

The Complexities of HTA

2nd Annual Health Technology Assessment Conference

Dr Richard Bartlett

First Assistant Secretary

Medical Benefits Division

Topics

HTA in Australia

Complexities, Challenges & Reforms

Prostheses List

MBS

Future directions

HTA in Australia

Government conducts HTA to maximise beneficial

health outcomes to the Australian population within

the overall funds available while being cognisant of

the other important goals of the health system.

Australian HTA Landscape

The Prostheses List

The Prostheses List allows privately insured patients access to prostheses which are reimbursed through benefits paid by private health insurers as part of hospital treatment (under the Private Health Insurance Act 2007).

Currently over 9,900 products listed and is updated biannually with over 800 applications per year.

Latest List - published August 2013.

Prostheses List Challenges

Evidence

Need for high evidentiary standards and

rigour.

Evaluations

Fit-for-purpose, risk-appropriate?

Process efficiency

Review mechanisms.

Prostheses List Challenges

New and emerging technologies

Efficient and timely access to promising

technologies.

Benefit setting

Outcomes

Clinical benefits, cost savings, efficiency

gains.

Prostheses List & PLAC Reforms

Application processes and procedures

PLAC Review Working Group

New application management database

Targeted engagement with stakeholders

Benefit setting arrangements

Health Economists Working Group.

Comprehensive Management

Framework for the MBS

Commitment to ensure the MBS supports cost-

effective, evidence-based best practice.

Continuing to seek independent expert advice

from MSAC on the circumstances under which

public funds should be used to support medical

services.

MBS Challenges

Evidentiary requirements

Co-dependent technologies

Disinvestment

Quality of assessments and data collection

One-size-fits-all HTA model

Increasingly clear that parts of the process can

be unnecessarily complex for some

applications.

MBS and MSAC Reforms

Governance arrangements

Stakeholder engagement

Streamlined processes

Review of MBS items.

Review of MBS Items

Overview and objectives

Processes and challenges

Current status.

Why do we need MBS reviews

Improve health outcomes

Efficient use of resources

Value for money

Consistency.

MBS Reviews - Objectives

Ensure the safety, quality and sustainability of

the MBS by reviewing the evidence to support

MBS items and clinical practice.

MBS Reviews - Challenges

An ageing population

Increase in chronic disease

Increasing health costs

Advances in medical technology and associated

costs.

Review Triggers

Triggers for reviews may include one or more of the

following:

Increased service growth and MBS

expenditure

Obsolete or out of date services

Need to align with current clinical practice

Evidence – literature reviews and data

International activities.

MBS Reviews process

Consultation to define the review scope.

Identification of the review pathways

MBS issues

Policy issues.

Consultation to finalise the protocol.

Analysis of evidence based on protocol

specifications.

Consideration by PASC, ESC and MSAC

Advice to the Minister.

Current program of MBS Reviews

Botulinum toxin injection

Cardiac procedures and

implantable electronic devices

Carotid vessel surgery

Ear, nose and throat surgery

Inguinal hernia repair

Knee arthroscopy

Lipectomy

Ophthalmology stage 2

Paediatric services

Perfusion services

Radiation oncology services

Rhinoplasty

Skin services

Varicose vein surgery

Vitamin B12/Folate testing

Vitamin D testing

Vulvoplasty

Wrist ganglion surgery

Successes

Address quality and safety issues to improve

outcomes for patients.

MBS impact - sustain service and expenditure

growth and reduce MBS item creep (where use has

altered beyond the original purpose).

Clinical impact - links to national health priority areas

(asthma and cancer).

Redirect service provision to more evidence-based

treatment options and/or reduce MBS complexity or

duplication.

Streamlining and improving links

between MSAC and PLAC

MSAC involving PLAC in initial assessments for

medical services that require devices.

Enables PLAC to get applications advanced

prior to MSAC listing.

Where to from here - PLAC

Development of standard application process

More effective use of Health Economists

Assessment of products

Improved linkages with TGA

Improved administrative arrangements

Review of application guidelines.

Where to from here - MSAC

Move to risk-based fit-for-purpose HTA

pathways (‘triage’)

Availability of resources and the capacity to

undertake evidence based reviews.

Further refinement and improvement to

evidence based processes to make them more

flexible, responsive and avoid duplication.

The need for stakeholders to work with us.

Contact details

HTA hotline – (02) 6289 7550

HTA email – hta@health.gov.au

PLAC email – prostheses@health.gov.au

MSAC website – www.msac.gov.au

MBS reviews – mbsreviews@health.gov.au