Description of Medical ServiceSubacromial decompression is a surgical procedure used in the treatment and management of shoulder pain due to subacromial impingement. It can be used as a standalone therapy or in conjunction with rotator cuff repair surgery. Subacromial decompression is the widening of the space where the tendons pass by removal of the swollen or inflamed bursa (bursectomy) or bone (acromioplasty). Subacromial decompression is performed through an open or arthroscopic approach.
Description of Medical ConditionThe rotator cuff of the shoulder comprises four muscles, and their respective tendons, that raise or rotate the upper arm. Rotator cuff diseases encompass a wide array of conditions, including rotator cuff tendinopathy or tendinitis, subacromial impingement syndrome, partial or complete rotator cuff tears, calcific tendinitis, and subacromial bursitis. Symptoms can include pain at the upper outer arm when lifting the arm, difficulty moving the arm, reduced strength in the arm, and sleep disturbance due to pain. Shoulder pain can impair capacity to work, causing time off, and affect performance of household tasks.
Reason for ApplicationAn evidence review of MBS items for subacromial decompression will be conducted and considered by the Medical Service Advisory Committee to ensure government funding of subacromial decompression in Australia is based on strong evidence of clinical and cost effectiveness. The currently subsidised MBS items for subacromial decompression (by acromioplasty) are MBS item 48903 and MBS item 48909.
Terms of ReferenceThe Terms of Reference for the review were to:
- Review clinical guidelines on the management of rotator cuff disease, taking account of the clinical characteristics of the population/s recommended for subacromial decompression (with/without rotator cuff repair).
- Review the utilisation of subacromial decompression services, informed by MBS data and other data that may provide additional insight into clinical use.
- Review evidence on comparative safety and clinical effectiveness of subacromial decompression (with/without rotator cuff repair) used in the management of rotator cuff disease. The evidence review will be based on the Population, Intervention, Comparator and Outcomes (PICO) confirmation ratified by the PICO Advisory Subcommittee.
- Subject to the findings of Terms of Reference 1, 2 and 3, review and evaluate the cost effectiveness of subacromial decompression (with/without rotator cuff repair).
Following consideration by PASC, subacromial decompression as a part of rotator cuff repair surgery was removed from the scope of the current review.
Public and Targeted Consultation on the ReviewMSAC values input from individuals and organisations. There will be two opportunities for interested stakeholders to contribute to the Review of MBS items for subacromial decompression and outline key points they wish MSAC to consider. Consultation input can be provided to the Department via commentsMSAC@health.gov.au. Please include the MSAC application number  in the subject heading of your email.
Consultation submissions will be provided to the independent health technology assessment group to inform the review and to MSAC and its sub-committees — the PICO Advisory Sub Committee (PASC) and the Evaluation Sub Committee (ESC). Consultation input may be cited in the PICO confirmation, Assessment Report and MSAC Public Summary Document which will be published on the MSAC website, including attribution to the organisations providing input. Further information is available at MSAC Consultation FAQ.
Consultation Period 1
The first consultation period comprised the following two components.
Stakeholders were invited to provide submissions to MSAC on any aspects of terms of reference 1-4 to inform the evidence review. Submissions for the terms of reference closed on 11 March 2022.
The draft PICO confirmation, together with the review of clinical guidelines on the management of rotator cuff disease (terms of reference 1), were provided to key stakeholders and published on 11 March 2022 for consultation ahead of the 13-14 April 2022 PASC meeting. Consultation comments on the draft PICO confirmation and/or clinical guidelines review closed on 31 March 2022. PASC considered the draft PICO confirmation, clinical guidelines review and stakeholder input. The PICO Confirmation was ratified by the PASC and published on the MSAC website.
Questions for consultation were included in the Draft PICO confirmation (p.23) and clinical guidelines review (pp.13-14). Consultation input was not limited to these questions and could be received on any aspect of the Draft PICO confirmation and clinical guidelines review.
Consultation Period 2
The evidence review (Assessment Report) was provided to key stakeholders and published on the MSAC website for comment ahead of the February 2023 Evaluation Sub-committee (ESC) meeting. MSAC considered the review, stakeholder input and the advice of the ESC at the
March 2023 meeting.
Draft PICO ConfirmationDraft PICO Confirmation (PDF 926 KB)
Draft PICO Confirmation (Word 1293 KB)
Clinical Guidelines reviewClinical Guidelines Review (PDF 879 KB)
Clinical Guidelines Review (Word 373 KB)
Final PICO Confirmation (PDF 1026 KB)
Final PICO Confirmation (Word 1221 KB)
Assessment ReportAssessment report (PDF 3468 KB)
Assessment report (Word 3738 KB)
Public Summary DocumentPublic Summary Document (PDF 573 KB)
Public Summary Document (Word 244 KB)