The Economics of health technology assessment research stream at Deakin Health Economics works collaboratively with the Commonwealth Department of Health undertaking evaluations of:
- medicines considered by the Pharmaceutical Benefits Advisory Committee (PBAC) that are seeking listing on the Pharmaceutical Benefits Scheme (PBS); and
- medical services considered by the Medical Services Advisory Committee (MSAC) that are seeking listing on the Medicare Benefits Schedule (MBS)
Our work contributes to ensuring that only safe, effective and cost-effective medicines and medical services are publicly subsidised in Australia under their respective schemes.
The Economics of health technology assessment team has also undertaken post-market reviews of medicines listed on the PBS and evaluations for the Ministry of Health, New South Wales and Agency for Care Effectiveness (ACE) in Singapore.
General information about the evaluations:
Although the work conducted for the PBAC and MSAC varies slightly, common requirements are:
- assessment of the appropriateness of the proposed positioning or clinical place of the intervention/service that can be used in the management of a condition, most importantly to define appropriate comparator(s)
- ensuring that intended use is consistent with relevant regulatory approvals
- conducting/checking a systematic search of the literature (including ongoing trials) to ensure that reports of all studies relating to the clinical question at hand (and those that may become relevant in future) have been identified
- conducting or checking that clinical data from published and unpublished reports of clinical studies are systematically and accurately extracted, analysed, synthesised
- preparing/commenting on a summary conclusion in regard to the comparative effectiveness and safety
- validating the accuracy or developing de novo models for economic evaluations. This includes the conduct of cost-minimisation analyses and full modelled economic evaluations, including decision trees, Markov cohort and microsimulation models
- validating the accuracy or developing de novo models to estimate the financial implications when considering public subsidy. Estimates derived from epidemiological or market share approaches
Medical Services Advisory Committee Evaluations
We have been undertaking evaluations for MSAC for medical services (for example, medical procedures and diagnostic tests) seeking listing on the MBS since 2007. The work is varied and includes:
- development or critique of PICO Confirmations (protocols for how an evaluation should be conducted). These determine the Patient, Intervention, Comparator and Outcomes (PICO) of interest to a particular assessment. PICO Confirmations are considered by the PICO Advisory Sub-committee (PASC; a sub-committee of the MSAC)
- conduct of a Department Contracted Assessment Report (DCAR). We undertake a systematic search of the literature to assess the comparative safety and effectiveness of an intervention in a particular patient group compared with its most relevant alternative (comparator). We then proceed with an economic evaluation to determine ‘value for money’ and an estimation of the budgetary impact should the intervention be listed on the MBS. The type of economic evaluation and approach to estimating budgetary impact is determined by the conclusion of the comparative safety and effectiveness of the intervention versus its comparator
- critique of an Applicant Developed Assessment Report (ADAR). We evaluate the accuracy and completeness of the systematic literature search, data synthesis, economic evaluation and estimated budgetary impact in assessments conducted by applicants (usually the practitioners who will provide the medical services or manufacturers of devices or diagnostic tests)
All of these aim to highlight the main clinical and economic issues relevant to decision making.
Our DCARs and critiques of ADARs are considered by the Evaluation Sub-Committee (ESC, a sub-committee of the MSAC) and MSAC. MSAC makes a decision whether to support or not support the application for listing a particular medical service on the MBS.
Some of the work we conduct for MSAC is commercial-in-confidence and cannot be published, while others are publicly available.
Pharmaceutical Benefits Advisory Committee Evaluations
We have been undertaking evaluations for the PBAC for medicines seeking listing on the PBS since 2012. All work we conduct for the PBAC is commercial-in-confidence.
We evaluate the accuracy and completeness of the systematic literature search, data synthesis, economic evaluation and estimated budgetary impact in assessments conducted by sponsors of the medicine (usually the manufacturer). Typical PBAC evaluations are approximately 40,000 to 60,000 words, consisting of an Executive Summary which forms the basis of the Public Summary Documents and a more comprehensive report which is made available to the PBAC and its sub-committees (the Economic Sub-Committee (ESC) and Drug Utilisation Sub-Committee (DUSC)). All these reports aim to highlight the main clinical and economic issues relevant to decision making. The PBAC makes recommendations on whether a particular medicine should be listed on the PBS.
In addition to evaluations of specific pharmaceuticals or tests/procedures for the PBAC and MSAC, we’ve also been involved in post-market reviews of therapies currently listed on the PBS and undertaken evaluations for the Ministry of Health, New South Wales and Agency for Care Effectiveness (ACE) in Singapore.
Members of our team also contribute in other areas of health technology assessment, including membership of Advisory Committees and the provision of advice/recommendations for schemes other than the MBS and PBS.
While our major focus is the conduct of health technology assessment evaluations, wider activities within Deakin Health Economics include economic evaluations alongside randomised controlled trials, cost of illness studies, assessment of preferences, as well as teaching health technology assessment as part of Deakin University’s Master of Health Economics.
Brief examples of our more recent work spanning these areas of research include:
MSAC 1570 PICO Confirmation: PD-L1 (Programmed Death Ligand 1) immunohistochemistry (IHC) testing for access to atezolizumab as first-line therapy for patients with locally advanced or metastatic triple-negative breast cancer (TNBC).
Ghijben P, Gu Y, Lancsar E, Zavarsek S. Revealed and stated preferences of decision makers for priority setting in health technology assessment: A systematic review. 2018. Pharmacoeconomics, 36 (3): 323-40.
Hocking J, Temple-Smith M, Gut R, Donovan B, Braat S, Law M, Gunn J, Regan D, Vaisey A, Bulfone L, Kaldoe J, Fairley C, Low N, ACCEPt Consortium. 2018. Population effectiveness of opportunistic chlamydia testing in primary care in Australia: a cluster-randomised controlled trial. Lancet, 392: 1413-22.
Barker AL, Morello RT, Wolfe R, Brand CA, Haines T, Hill K, Brauer S, Botti M, Cumming RG, Livingston PM, Sherrington C, Zavarsek S, Lindley R, Kamar J. 6-PACK program to decrease fall-related injuries in acute hospitals: a cluster randomised controlled trial. 2016. British Medical Journal, 352: h6781.
Dieleman J, Myles P, Bulfone L, Younie S, van Zaane B, McGiffin D, Moodie L, Gao L. 2020. Cost-effectiveness of routine transoesophageal echocardiography during cardiac surgery a discrete-event simulation study. British Journal of Anaesthesia, 124: 136-45.
Ong J, Chen M, Hocking J, Fairley C, Carter R, Bulfone L, Hsueh A. 2015. Chlamydia screening for pregnant women aged 16-25 years attending an antenatal service: a cost-effectiveness study. BJOG: an international journal of obstetrics and gynaecology, 1-9.
Westbrook JI, Gospodarevskaya E, Li L, Richardson KL, Roffe D, Heywood M, Day RO, Graves N. 2015. Cost-effectiveness analysis of a hospital electronic medication management system. J Am Med Inform 22(4):784-93.
Cost of illness studies:
Morello RT, Barker AL, Watts JJ, Haines T, Zavarsek S[S], Hill KD, Brand C, Sherrington C, Wolfe R, Bohensky MA, Stoelwinder JU. 2015. The extra resource burden of in-hospital falls: a cost of falls study. Medical Journal of Australia, 203 (9): 367.
Economics of health technology assessment research stream staff
Associate Professor Silva Zavarsek
Senior Research Fellow
Senior Research Fellow
Senior Research Fellow
Click on each staff member’s name for a full list of outputs related to this stream.