This page provides an overview of the process for most applications on the standard pathway. The process may differ for some applications, services or technologies. For more detail, see the process for applicants and assessment pathways for applicants.
Health technology assessment (HTA) framework
We use a health technology assessment (HTA) framework to assess applications for public funding. The framework includes:
- a PICO to describe the population, intervention, comparator and outcome for the health service or technology
- an assessment report (developed by the applicant or an HTA group) to review the clinical evidence and conduct economic and financial evaluations of the service or technology
- an independent critique (commentary) of applicant-developed assessment reports
- consultation input from stakeholders.
The suitability stage in our process includes confirming applications are suitable for an HTA.
Other committees also conduct HTAs for government subsidies.
High-level MSAC process
Lodge application form to start the pre-assessment phase. This phase has 3 stages:
- suitability
- PICO confirmation development (including pre-PASC consultation)
- PASC consideration.
Lodge assessment report to start the assessment phase. This phase has 2 stages:
- ESC consideration (including pre-MSAC consultation)
- MSAC consideration.
The MSAC process has 2 separate phases:
- The pre-assessment phase starts when an applicant lodges an MSAC application form.
- The assessment phase starts when an applicant or HTA group lodges an assessment report.
Most applicants will develop and lodge their own assessment report. For some applicants, our secretariat may agree to contract an HTA group to develop the assessment report.
Assessment pathways
All applications must go through both phases of the MSAC process, but they may bypass some stages. This depends on the assessment pathway of the application:
- Most applications will follow the standard pathway. This pathway requires an application to go through all stages of the MSAC process, including consideration by both our subcommittees.
- Applications with a clear PICO may follow the expedited pathway. This pathway allows an application to bypass PICO confirmation development and PASC consideration.
- Less complex applications may follow the direct pathway. This pathway allows an application to bypass PICO confirmation development, PASC consideration and ESC consideration.
The assessment pathway decision is part of the suitability stage.
Application form
Applicants must complete and lodge an application form to start the pre-assessment phase. This includes:
- a PICO for their service or technology
- a summary of their claims and supporting evidence.
If an application is found suitable in the pre-assessment phase, the applicant must provide more detailed evidence and analyses in the assessment report.
Pre-assessment phase
This phase checks the application is suitable for the MSAC process and confirms the PICO is accurate. There are 3 stages in this phase.
Suitability
This stage of the pre-assessment phase:
- ensures applications are complete, in scope for MSAC and suitable for an HTA
- confirms the nominated funding program is appropriate
- decides the best assessment pathway for suitable applications.
For applications on the:
- standard pathway – consultation starts once our secretariat has published the relevant PASC meeting agenda and the redacted application form on an application page
- expedited or direct pathway – consultation starts later.
Find out more about when consultation starts.
PICO confirmation development
All applications must include a PICO ( population, intervention, comparator, outcome) to describe:
- who would be able to use the proposed health service or technology (population). For example, people with a specific health condition or in a specific age group or disease stage.
- the proposed health service or technology and how it would be delivered (intervention)
- how the health condition is currently managed in Australia (comparator). If there is currently no way to manage the health condition, then this may say ‘no comparator’ or ‘best supportive care’.
- how the effect of the proposed health service or technology would be measured (outcome). Outcomes can be immediate, such as reduced pain, or happen in the future, such as improved 5-year survival rates. Outcomes can be felt by the person or the health system, or both. For example, reduced hospitalisations.
A PICO is important because it provides the framework for the assessment report in the assessment phase.
In this stage, our secretariat usually contracts an HTA group to consider the applicant’s PICO and draft a PICO confirmation document. The PICO confirmation should look at the best available evidence to ensure the PICO is as accurate as possible.
The applicant can respond to the draft PICO confirmation and any consultation input (this is their pre-PASC response) before the next stage.
PASC consideration
This stage includes consideration by our PICO Advisory Subcommittee (PASC) at a PASC meeting.
The steps in this stage are:
- PASC meets to review the draft PICO confirmation and the applicant’s pre-PASC response from the previous stage, and consider consultation input
- the HTA group updates the draft in line with PASC advice
- PASC ratifies (finalises) the PICO confirmation
- the applicant comments on the ratified PICO confirmation
- our secretariat publishes the ratified PICO confirmation on the relevant application page.
Assessment report development
Once the pre-assessment phase is complete, the applicant or an HTA group develops an assessment report for the application. Most applicants will develop and lodge their own assessment report. It is a complex document, and some applicants may not lodge their assessment report immediately.
The report should discuss the key assessment questions in detail and include:
- an evaluation of the clinical evidence, including comparative safety and effectiveness
- an economic evaluation to assess value for money
- the likely usage of the service or technology and how this would affect the government financially.
The report should be in line with MSAC guidelines and the ratified PICO confirmation from the PASC consideration stage (if applicable).
Assessment phase
This phase starts after the applicant or an HTA group lodges an assessment report for the application. This phase has 2 stages to consider the assessment report and application in detail. Applications on the direct pathway bypass ESC consideration.
ESC consideration
This stage includes consideration by our Evaluation Subcommittee (ESC) at an ESC meeting.
The first couple of steps in this stage depend on who developed the assessment report. If the applicant developed the assessment report:
- our secretariat contracts an HTA group to review the assessment report in a commentary
- the applicant provides a pre-ESC response to the commentary.
If an HTA group developed the assessment report:
- the applicant provides a pre-ESC response to the assessment report
- the HTA group may provide a rejoinder to address the applicant’s pre-ESC response.
Our ESC members then meet to consider all relevant documents and any consultation input. Their ESC report:
- provides advice on the quality, validity and relevance of evidence in the assessment report
- identifies any issues we should consider in the next stage.
MSAC consideration
This stage includes appraisal at an MSAC meeting and the development of MSAC advice.
In this stage, the applicant comments on the ESC report and consultation input in their pre-MSAC response. We then meet to consider all relevant documents including:
- the application, the assessment report and related documents
- the applicant's pre-ESC and pre-MSAC responses
- PASC and ESC advice
- consultation input.
At the meeting, we decide our advice on whether the application should receive funding (the assessment outcome). Our secretariat:
- provides our advice to the federal health minister shortly after our meeting
- publishes our advice (and the reasons for this advice) in a public summary document. This will be available on the relevant application page.