The Department reports to MSAC on the utilisation of MBS items. To ensure that new items or item amendments are being used as intended, a predicted vs actual (PvA) utilisation monitoring process has been established for services MSAC has supported and the Department of Health has subsequently listed on the Medicare Benefits Schedule (MBS). This process is not intended to be a review of the clinical information provided during the application process. The PvA utilisation monitoring process assesses the real-world impacts of MSAC-supported applications by comparing projections of claims with actual service volume patterns 24 months after listing.
MSAC can make recommendations in relation to:
- referring inappropriate co-claiming of services to the Department compliance area;
- the MBS item descriptor and fee for the service requiring amendment;
- identifying issues with access to services;
- other matters related to the public funding of health services.
Applications reviewed at the November 2016 MSAC meeting are:
- Application 1161 - Gefitinib first line testing for mutations of epidermal growth factor receptor (EGFR) in patients with metastatic non-small cell lung cancer (NSCLC)
- Application 1168 - Injection of BOTULINUM TOXIN (Botox) for prophylaxis of headaches in adults with chronic migraine
- Application 1173 - EGFR mutation test for treatment of locally advanced (stage IIIB) or metastatic (stage IV) NSCLC for access to erlotinib
- Application 1207 - Diagnostic testing to determine the presence of V600 mutations in patients with locally advanced or metastatic melanoma
- Application 1221 - Transurethral injection of botulinum toxin into the bladder wall for urinary incontinence due to neurogenic detrusor overactivity
- Application 1223 - Insertion, replacement or removal of a cardiac resynchronisation therapy device capable of defibrillation for mild chronic heart failure