Applications

1190 – MRI for small bowel and pelvis in Crohn disease

Find out about the service or technology in this application and the medical condition it addresses. You can also view the application documents, the deadlines for providing consultation input and the outcome of the application when the MSAC process is complete.

  • Status Complete
  • Type New application
  • Pre-PASC consultation -
  • Pre-MSAC consultation -
  • Outcome Supported

Application details

Reason for application

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Service or technology in this application

The proposal relates to a new item on the Medicare Benefits Schedule for MRI for patients with Crohn disease, specifically:

  1. for the small intestinal Crohn disease to distinguish inflammatory Crohn disease from complicated Crohn disease (fibrotic or fistulising disease). This distinction is clinically important, since treatment options differ for the two circumstances (medical treatment for inflammatory disease; surgery for intestinal complications). The powerful advantage of MRI is that it does not involve radiation, and is therefore much safer for patients who usually require multiple tests over a lifetime.
  2. for the pelvis to evaluate for pelvic sepsis and fistulas. It permits comprehensive assessment and allows triaging of patients to medical or surgical therapy.

Medical condition this application addresses

Crohn disease is a life-long, inflammatory disorder of the gastrointestinal tract affecting 1/600 Australians. Its onset occurs at any time, often in teenagers and young adults. Initially, inflammation affects the inner lining of the gut wall but may eventually progress to involve the entire bowel wall segment, resulting in complications such as scarring, abscess or fistula.

The symptoms, investigations and therapy depend on the anatomical site and stage of inflammation. Gastro-intestinal inflammation results in diarrhoea, abdominal pain, bleeding, and weight loss. Progressive intestinal scarring leads to nausea, vomiting, pain and bowel obstruction. Intestinal perforation leads to intra-abdominal abscess, fistula or peritonitis.

Perianal or rectovaginal fistula cause anal pain, discharge, incontinence and impaired sexual function. Extra-intestinal associations include anaemia, nutritional deficiencies, osteoporosis, arthritis and skin reactions. Crohn disease impairs quality of life, and impacts adversely on education, work, personal relationships and recreational pursuits. Crohn disease is associated with substantial psychological morbidity.

Application documents

PICO confirmation

Assessment report

Public summary document

Predicted versus actual

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Meetings to consider this application

  • PASC meeting: 
    • 12 – 13 April 2012
    • 16 – 17 August 2012
  • ESC meeting: 
    • 13 – 14 February 2014
  • MSAC meeting: 
    • 3 – 4 April 2014
    • 2 March 2018
    • 6 December 2019