The impact of orthopaedic research evidence on health financing in Australia

Martin Hua,Lachlan Host,Daniel Myers

doi:10.1186/s12961-018-0314-0

Abstract

BackgroundIn Australia, approval by the Medical Services Advisory Committee (MSAC) is an important step in the implementation of new health technologies. The MSAC considers health technology assessments (HTA) when submitting a recommendation to the Minister of Health on a new technology’s suitability for public funding. Despite being such a critical tool in formulating policy, there has been little scrutiny on the impact of limited evidence on the performance of a national HTA agency’s mandate. We aim to determine the proportion of HTAs of orthopaedic technologies prepared for the MSAC that were supported by higher levels of evidence for effectiveness, and whether this affected the MSAC’s ability to conclude on efficacy. We also investigated whether the availability of higher level evidence affected the performance of cost-effectiveness analyses.MethodsWe performed a cohort study of all HTAs prepared for the MSAC from 1998 to 2017 with regards to new technologies in orthopaedic surgery.ResultsWe identified seven HTAs encompassing nine orthopaedic technologies for inclusion. Higher levels of evidence were available for assessing the technology’s effectiveness in six out of the nine technologies. The results did not show a statistically significant relationship between the availability of higher level evidence and MSAC’s ability to make a clear conclusion on the assessment of effectiveness (P = 0.5). The proportion of HTAs where a cost-effectiveness analysis was performed was significantly higher (P < 0.05) when higher levels of evidence were available for the assessment of effectiveness.ConclusionsThe results indicate that there is a paucity of high quality evidence in the formulation of health policy with regards to the implementation of new orthopaedic technologies in the public healthcare system. This represents an opportunity for strong leadership from surgeons to help develop the tools needed for effective clinical decision-making.

Highlights

In Australia, approval by the Medical Services Advisory Committee (MSAC) is an important step in the implementation of new health technologies
In Australia, one study noted that only 19.6% of orthopaedic procedures currently performed had at least one randomised controlled trial (RCT) supporting the operative treatment over non-operative alternatives [2]
Our aims were to (1) determine the proportion of the total health technology assessments (HTA) performed by the MSAC, in relation to orthopaedic technologies, that were supported by higher levels of evidence, (2) determine whether the availability of higher level evidence affected MSAC’s conclusion of effectiveness, and (3) investigate whether the availability of higher level evidence limited the performance of costeffectiveness analyses by MSAC

Summary

Introduction

In Australia, approval by the Medical Services Advisory Committee (MSAC) is an important step in the implementation of new health technologies. The MSAC considers health technology assessments (HTA) when submitting a recommendation to the Minister of Health on a new technology’s suitability for public funding Despite being such a critical tool in formulating policy, there has been little scrutiny on the impact of limited evidence on the performance of a national HTA agency’s mandate. We investigated whether the availability of higher level evidence affected the performance of cost-effectiveness analyses It is incumbent upon policy-makers to use evidencebased medicine to guide decisions with regards to which medical services and procedures should be allocated government funds. In Australia, one study noted that only 19.6% of orthopaedic procedures currently performed had at least one RCT supporting the operative treatment over non-operative alternatives [2] Evidence shows that this has impacted on clinical decision-making on a day-to-day basis and healthcare

Objectives

Methods

Results

Conclusion