1711 – Review of MBS items for subacromial decompression

An 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.

The Terms of Reference for the review were to:

1. 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).
2. Review the utilisation of subacromial decompression services, informed by MBS data and other data that may provide additional insight into clinical use.
3. 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.
4. 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).

The Terms of Reference were endorsed by MSAC. The review will also consider the MBS review recommendations regarding acromioplasty and the summary of the issues raised by the Implementation Liaison Group for subacromial decompression.

Following consideration by PASC, subacromial decompression as a part of rotator cuff repair surgery was removed from the scope of the current review.

Subacromial 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.

The 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.

MSAC 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 [1711] 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.

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.

• PASC meeting: 13–14 April 2022
• ESC meeting: 9–10 February 2023
• MSAC meeting: 30–31 March 2023