The Australian experiment: the use of evidence based medicine for the reimbursement of surgical and diagnostic procedures (1998–2004)
Identifieur interne : 007A04 ( Main/Merge ); précédent : 007A03; suivant : 007A05The Australian experiment: the use of evidence based medicine for the reimbursement of surgical and diagnostic procedures (1998–2004)
Auteurs : Sue P. O'Malley [Australie]Source :
- Australia and New Zealand Health Policy [ 1743-8462 ] ; 2006.
Abstract
In 1998 a formal process using the criteria of safety, effectiveness and cost-effectiveness (evidence based medicine) on the introduction and use of new medical procedures was implemented in Australia. As part of this process an expert panel, the Medical Services Advisory Committee (MSAC) was set up. This paper examines the effectiveness of this process based on the original criteria, that is, evidence based medicine.
The data for this analysis was sourced primarily from that made available in the public domain. The MSAC web site provided Minutes from MSAC meetings; Annual Reports; Assessment and Review reports; Progress status; and Archived material.
The total number of applications submitted to the MSAC has been relatively low averaging approximately only fourteen per year. Additionally, the source of applications has quickly shifted to the medical devices, equipment and diagnostic industry as being the major source of applications. An overall average time for the processing of an application is eighteen months. Negative recommendations were in most cases based on insufficient clinical evidence rather than clinical evidence that clearly demonstrated a lack of clinical effectiveness. It was rare for a recommendation, either positive or negative, to be based on cost-effectiveness.
New medical procedures are often the result of a process of experimentation rather than formally conducted research. Affordability and the question of who should pay for the generation, collection and analysis of the clinical evidence is perhaps the most difficult to answer. This is especially the case where the new procedure is the result of a process of experimentation with an old procedure. A cost-effective way needs to be found to collect acceptable levels of evidence proving the clinical effectiveness of these new procedures, otherwise the formal processes of evaluation such as that used by the Australian MSAC since 1998 will continue to run the risk of committing Type II errors, that is, denying access to medical procedures that are beneficial and efficient.
Url:
DOI: 10.1186/1743-8462-3-3
PubMed: 16684362
PubMed Central: 1524967
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O'Malley</name><affiliation wicri:level="1"><nlm:aff id="I1">Medical Intelligence, 13 Cudgee Street, Turramurra NSW 2074, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Medical Intelligence, 13 Cudgee Street, Turramurra NSW 2074</wicri:regionArea><wicri:noRegion>Turramurra NSW 2074</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">16684362</idno><idno type="pmc">1524967</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1524967</idno><idno type="RBID">PMC:1524967</idno><idno type="doi">10.1186/1743-8462-3-3</idno><date when="2006">2006</date><idno type="wicri:Area/Pmc/Corpus">001B02</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001B02</idno><idno type="wicri:Area/Pmc/Curation">001B01</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">001B01</idno><idno type="wicri:Area/Pmc/Checkpoint">003C23</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">003C23</idno><idno type="wicri:Area/Ncbi/Merge">002224</idno><idno type="wicri:Area/Ncbi/Curation">002224</idno><idno type="wicri:Area/Ncbi/Checkpoint">002224</idno><idno type="wicri:Area/Main/Merge">007A04</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Australian experiment: the use of evidence based medicine for the reimbursement of surgical and diagnostic procedures (1998–2004)</title><author><name sortKey="O Malley, Sue P" sort="O Malley, Sue P" uniqKey="O Malley S" first="Sue P" last="O'Malley">Sue P. O'Malley</name><affiliation wicri:level="1"><nlm:aff id="I1">Medical Intelligence, 13 Cudgee Street, Turramurra NSW 2074, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Medical Intelligence, 13 Cudgee Street, Turramurra NSW 2074</wicri:regionArea><wicri:noRegion>Turramurra NSW 2074</wicri:noRegion></affiliation></author></analytic><series><title level="j">Australia and New Zealand Health Policy</title><idno type="eISSN">1743-8462</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>In 1998 a formal process using the criteria of safety, effectiveness and cost-effectiveness (evidence based medicine) on the introduction and use of new medical procedures was implemented in Australia. As part of this process an expert panel, the Medical Services Advisory Committee (MSAC) was set up. This paper examines the effectiveness of this process based on the original criteria, that is, evidence based medicine.</p></sec><sec sec-type="methods"><title>Method</title><p>The data for this analysis was sourced primarily from that made available in the public domain. The MSAC web site provided Minutes from MSAC meetings; Annual Reports; Assessment and Review reports; Progress status; and Archived material.</p></sec><sec><title>Results</title><p>The total number of applications submitted to the MSAC has been relatively low averaging approximately only fourteen per year. Additionally, the source of applications has quickly shifted to the medical devices, equipment and diagnostic industry as being the major source of applications. An overall average time for the processing of an application is eighteen months. Negative recommendations were in most cases based on insufficient clinical evidence rather than clinical evidence that clearly demonstrated a lack of clinical effectiveness. It was rare for a recommendation, either positive or negative, to be based on cost-effectiveness.</p></sec><sec><title>Conclusion</title><p>New medical procedures are often the result of a process of experimentation rather than formally conducted research. Affordability and the question of who should pay for the generation, collection and analysis of the clinical evidence is perhaps the most difficult to answer. This is especially the case where the new procedure is the result of a process of experimentation with an old procedure. A cost-effective way needs to be found to collect acceptable levels of evidence proving the clinical effectiveness of these new procedures, otherwise the formal processes of evaluation such as that used by the Australian MSAC since 1998 will continue to run the risk of committing Type II errors, that is, denying access to medical procedures that are beneficial and efficient.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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