1190 - MRI for small bowel and pelvis in Crohn disease
|Application Name||Magnetic Resonance Imaging (MRI) for small bowel and pelvis in Crohn disease|
|Assessment Type||To be advised by Applicant|
|Description Of Medical Service||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.
|Description Of Medical Condition||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.
|Stage 2 – Suitability for Assessment||16 August 2012|
|Proposed DAP Received||9 January 2011|
|Stage 3 – 1st PASC (Draft DAP considered)||12 – 13 April 2012|
|Stage 3 – Release for Public Comment (Consultation DAP)||Date released for comment 28 May 2012|
Consultation Decision Analytic Protocol (DAP) - PDF
Consultation Decision Analytic Protocol (DAP) - Accessible Word version
Date closed for comments 5 July 2012
(While every effort will be made to ensure that comments received by or after the close date would be provided to PASC, this could not necessarily be guaranteed.)
|Stage 3 – 2nd PASC (Final DAP)||16-17 August 2012|
Final Decision Analytic Protocol (DAP) - PDF
Final Decision Analytic Protocol (DAP) - Accessible Word version
|Stage 4 – Submission of Collated Evidence|
|Stage 5 – ESC Evaluation|
|Stage 6 – MSAC Appraisal|
|Stage 6 - MSAC advice|
|Stage 7 - Noting by Minister|
|Stage 8 - Implementation|
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