Application Detail

Status

Closed

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.

Reason for Application

-

Medical Service Type

-

Previous Application Number

Not Applicable

Associated Documentation

Application Form

-

PICO Confirmation

Final Protocol (PDF 438 KB)
Final Protocol (Word 730 KB)

Assessment Report

Contracted Assessment Report (PDF 1213 KB)
Contracted Assessment Report (Word 713 KB)

Public Summary Document

Public Summary Document (PDF 104 KB)
Public Summary Document (Word 84 KB)

Predicted versus Actual

Public Summary Document - Dec 2019 (PDF 253 KB)
Public Summary Document - Dec 2019 (Word 68 KB)

Meetings for this Application

PASC

12 – 13 April 2012
16 – 17 August 2012

ESC

13 – 14 February 2014

MSAC

3 – 4 April 2014
2 March 2018
6 December 2019