In the context of the Medical Services Advisory Committee (MSAC), co-dependent technologies are medical technologies that rely on another technology to achieve its intended purpose or enhance its effect.
A co-dependency occurs when the use of one health technology directly improves the health outcomes (e.g. a medicine, or medical device or procedure) by the use of another health technology (e.g. a pathology or an imaging diagnostic technology), which might more accurately identify patient subsets most likely to gain from the therapy or monitor therapy response.
There are a number of different scenarios for possible co-dependencies that involve medical services:
Therapeutic medical service + investigative medical service (both requiring funding approval through MSAC)Investigative medical service (funding approval through MSAC) + therapeutic pharmaceutical (funding approval through the Pharmaceutical Benefits Advisory Committee (PBAC)Consultative medical service (funding approval through MSAC) + therapeutic pharmaceutical (funding approval through PBAC)
What is a Hybrid Technology?Hybrid technologies combine the different characteristics of different health technologies within a single entity. Common examples of hybrid technologies are drug eluting stents or photodynamic therapy for treating skin diseases.
Co-dependent Application:A co-dependent application occurs where either one or both health technologies, which make up a co-dependent or hybrid technology, require consideration for public funding.
Codependent applications are required where the consideration by the MSAC of a medical service, relies on integrated information with a co-dependent drug or implantable device that the PBAC or the Prosthesis List Advisory Committee (PLAC), respectively also need to consider. Co-dependent submissions are lodged to the PBAC and MSAC process in parallel.
All applicants who undertake a co-dependent application must lodge a submission based assessment as they have access to info that Assessment Groups do not have; such as commercial-in-confidence data.
MSAC/PBAC Co-dependent Application:Co-dependent applications involve different governance arrangements and timings. MSAC’s PICO Advisory Sub-committee (PASC) timeframes for co-dependent applications are the same as for non co-dependant applications, although timeframes differ at the Evaluation Sub-committee (ESC) of MSAC and MSAC stages. MSAC meeting dates align between MSAC’s ESC and PBAC’s ESC, and in most cases, joint ESC meetings are held to consider a co-dependent application.
Applicants are encouraged to review the Guidelines for preparing Assessment Reports for MSAC and the associated templates on the MSAC website before lodging their submission based assessment in both committee Assessment Reports as the evidence will be presented in full in either the MSAC or PBAC Assessment Report. Some core information about the co-dependent therapy will need to be provided, in order to link the clinical conclusion of the investigative medical service to an economic analysis.
For PBAC co-dependent Assessment Reports, the PBAC requirement for report formatting and publication will prevail in acknowledgement of the different Government public funding arrangements, PBS listing, and established memorandum of understanding arrangements.
MSAC/PLAC co-dependent applications, unlike coordinated MSAC / PBAC processes, have currently no formal alignment of MSAC / PLAC processes and meetings. This is due to the role of the PLAC being to determine a reimbursement price for devices to be used in the private sector and applications exist independently, however can be submitted concurrently.
Devices will not be listed on the Prostheses List until there is a relevant corresponding MBS item for the associated medical service.