Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
J Med Imaging Radiat Oncol. 2022 Mar;66(2):215-224. doi: 10.1111/1754-9485.13386.
The Medical Services Advisory Committee (MSAC) is responsible for the assessment of medical imaging tests proposed for public funding. A number of factors related to the clinical or cost effectiveness of an imaging service may impact on the funding decision.
To determine what evidentiary and economic factors impact most on MSAC recommendations for the funding of imaging tests.
Information was extracted on health technology assessments (HTAs) of medical imaging tests published on the MSAC website, with a funding decision between 2006 to July 2021. Imaging tests with diagnostic, staging or screening indications were eligible. Data were extracted in test-indication pairs and included data on evidence quality, quantity, consistency of findings, cost-effectiveness and financial impact. Multivariate logistic regression analysis was performed with adjustments for clustered data.
Overall, 42 imaging test applications to MSAC were included, representing 91 clinical indications. Most were diagnostic tests. The most common evidentiary concerns reported by MSAC were limited evidence (36%), low quality evidence (26%), and applicability of the data (22%). The reference standard for diagnostic accuracy was imperfect or not appropriate in 25% of the indications. In regression analyses, uncertainty about cost-effectiveness of an imaging service predicted most negative funding decisions.
The single biggest contributor to a negative funding decision by MSAC was uncertainty about the cost-effectiveness of the imaging service. This was likely driven by uncertainty regarding the impact on patient health. HTAs that are able to demonstrate the clinical utility of a new imaging service are more likely to publicly funded.
医疗服务咨询委员会（MSAC）负责评估拟为公共资金提供的医学影像检查。与成像服务的临床或成本效益相关的许多因素可能会影响资金决策。
确定哪些证据和经济因素对 MSAC 为成像检查提供资金的建议影响最大。
从 MSAC 网站上发布的医疗成像技术评估（HTA）中提取有关 2006 年至 2021 年 7 月之间的资金决策的信息。具有诊断、分期或筛查适应症的成像检查符合条件。在测试-适应症对中提取数据，包括证据质量、数量、发现一致性、成本效益和财务影响的数据。采用多元逻辑回归分析，并对聚类数据进行调整。
总体而言，共有 42 项向 MSAC 提交的成像测试申请，涉及 91 种临床适应症。大多数是诊断性检查。MSAC 报告的最常见证据问题是证据有限（36%）、证据质量低（26%）以及数据的适用性（22%）。25%的适应症中，诊断准确性的参考标准不完美或不适用。在回归分析中，成像服务成本效益的不确定性预测了大多数负面资金决策。
MSAC 做出否定资金决策的最大原因是对成像服务成本效益的不确定性。这可能是由于对患者健康影响的不确定性所致。能够证明新成像服务具有临床效用的 HTA 更有可能获得公共资金。
