Health Technology Assessment The Australian Experience

1. Health TechnologyAssessmentThe Australian Experience Guy MaddernProfessor of Surgery University of Adelaide

4. Australia 2008 • MDEC (Medical Device Evaluation Committee) • MDIRC (Medical Device Incident Reporting Committee) • MSAC (Medical Service Advisory Committee) • ASERNIP-S (Australian Safety and Efficacy Registrar of New Interventional Procedures – Surgical)

5. MDEC • Formed under TGA • Comprises predominantly of clinicians • Looks at high risk implantable devices • Meets 4 times a year

6. MDEC Process • Expert review • Manufacturers response • Nominated clinicians review • Committee decision

7. Issues • Poor long term data • Poor study design • Cost/benefit difficult • Crowded market

8. MDIRC • All incidents reported are assessed • Committee of clinicians • Meets 4 times a year • Ad hoc advice

9. Advantages • Clinical review • Broad experience • Advice to Government available

10. Problems • Many incidents not reported • Slow to access • No linkage yet with - Coroner - AIMS - State quality units

11. MSAC • Attempts to assess - Safety - Efficacy - Cost • Clinician driven

12. Problems • Slow to evaluate • Confuses opinion with fact • Only assesss new unfunded technology

15. Staff

16. New Players • ASERNIP-S • HealthPACT • HTA State Committee • Prostheses and Devices Committee

17. Prostheses & Devices Committee(appointed by Minister of Health August 2004) • Big 6 • Stents • Hips • Knees • Ophthalmic Lenses • Pacemakers • Defibrillators

18. Prostheses & Devices Committee • CAG Clinical Advisory Group (Clinician) • BNG Benefits Negotiation Group (Health Fund Reps) No Gap Reimbursement

20. Productivity Commission • Assessment for devices less developed than drugs • MBS inclusion often incremental • MSAC often unsuitable • Prior to Prostheses Act little assessment occurred • P and D Committee focus on efficacy not cost effectiveness

21. Conclusions • MSAC Slow Little confusion • Fragmented HTA assessment • Potential for coordination

23. HTA Australia 2008 State HTA Committees MDEC Hospitals Surgeons MDIRC ASERNIP-S MSAC Productivity Commission HealthPACT Prostheses and Devices Committee