Adelaide Health Technology Assessment (AHTA) Life Impact | The University of Adelaide Tuesday, June 26, 2012 KEEPING AN ‘EYE’ ON THE PROBLEM: Developing a disinvestment methodology to review Australian medical services - ‘ophthalmology’ as a test case Tracy Merlin and Jackie Street
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Developing a disinvestment methodology to review Australian medical services - ‘ophthalmology’ as a test case.
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Adelaide Health Technology Assessment (AHTA)
Life Impact | The University of Adelaide
Tuesday, June 26, 2012
KEEPING AN ‘EYE’ ON THE PROBLEM:
Developing a disinvestment methodology to review Australian medical services - ‘ophthalmology’ as a test case
Tracy Merlin and Jackie Street
Background
2009-2010: • Government funding put aside to develop an evidence
based method of managing the Medicare Benefits Schedule into the future. » MBS Quality Framework
Broad aims:• Maximise health outcomes - safe, effective, appropriately
used• Promote efficient use of limited health care resources -
could we get better outcomes using our health dollar elsewhere?
What is the Medicare Benefits Schedule?
• List of services performed primarily by clinicians that are subsidised by the Government
Participants– Adelaide Health Technology Assessment , University of Adelaide –
consultants (responsible for the methodology, identification, analysis and synthesis of evidence)
– Clinical Working Group – experts in the field of ophthalmology– Australian Government Department of Health and Ageing – Consumer representation– Policy advisors – Medical Services Advisory Committee
Guiding principles– Evidence based– Fit for purpose– Consult key stakeholders
Challenge 1: What is the service?• MBS descriptors are non-descriptive
Item 42809 RETINA, photocoagulation of, not being a service associated with photodynamic therapy with verteporfin
WHAT IS IT?• Direct photocoagulation• Perifovial photocolagulation• Macular grid photocoagulation• Pan-retinal photocolagualtion• Continuous wave vs pulsed in micro, nano,
pico or femto seconds• Argon, YAG, Krypton, YLF, HeNe, Diode• 350nm to 750nm wavelength• Laser power levels from 1.5 to 8 Watts• Optically pumped semiconductor lasers
based on near-infrared-pumped quantum-well structures
WHY IT IS DONE?• Retinal detachment• Diabetic retinopathy• Choroidal neovascularisation
• Search limits: English language, humans, publ 2005-2011
• Hierarchical literature selection by study design: – Limit 1 – SRs– Limit 2 – controlled clinical trials, RCTs or
meta-analyses– Limit 3 - any articles + progressive
retrospective 5 year time periods
• Critical appraisal + narrative synthesis (NHMRC body of evidence matrix)
Ascertainment of consumer preferences
• Qualitative literature search – Embase.com, Scopus• Analysis of weblogs – identified through Google advanced
domain search. Commercial blogs excluded• Literature imported into NVivo – thematic coding and analysis
Styes...One became big and bad enough that I was prompted to see an eye doctor in Lapeer- not knowing he was going to remove it right there in his office- I was in for a huge surprise- They froze it- felt like they pulled my eyelid back and tied it to my ponytail- took the stye out- and left me with a huge bruise and a patch to cover it. That wont [sic] happen again- I assure you. I have since had styes- but use over the counter stye medication which seems to be doing a good job.
(TJ, United States, November 13, 2003).
Stakeholder negotiation
Review Process
• Protocol for Stage 1 drafted and released for public consultation – Dec 2010
• Stage 1: Review of 61 Medicare items undertaken using mixed methods approach– Tailored approach; not all items received all analyses– Oct 2011: released for public consultation – Review recommendations – only 20 / 61 services escaped
change– March 2012: recommendations provided to MSAC →
MSAC provided advice to Minister
• Stage 2: Review of remaining 23 Medicare items is underway
Merlin T, Street J, Holton C, Mundy L, Tamblyn D, Ellery B, Juneja V, Reddin E, Scrimgeour S, Hennessy S (2011) Review of MBS Items for specific ophthalmology services under the MBS Quality Framework. Canberra, ACT: Commonwealth of Australia