Medical Services Advisory Committee considerationThe Medical Services Advisory Committee (MSAC) considered the colonoscopy review report in November 2011. MSAC noted and agreed with the review’s finding that colonoscopy is a safe procedure, clinically effective in particular patient groups, and cost effective. No changes to the MBS are proposed as the result of the review.
The MSAC Public Summary Document, which includes the rationale for MSAC’s advice, is available here.
Draft Review ReportThe draft report of the review of MBS Colonoscopy items was released for public consultation on 20 July 2011.
The report is available below.
Draft Review Report - Colonoscopy (PDF 1197 KB)
Draft Review Report - Colonoscopy (Word 1446 KB)
A Summary of Conclusions Addressing the Clinical Research Questions:
Summary of Conclusions Addressing the Clinical Research Questions - Colonoscopy (PDF 81KB)
Summary of Conclusions Addressing the Clinical Research Questions - Colonoscopy (Word 42 KB)
Background and purpose of the reviewColonoscopy is indicated in the diagnosis and management of a broad range of clinical conditions. Medicare has provided reimbursement for around 3.4 million colonoscopies in Australia over the last decade. The primary purpose of this review was to conduct an evidence based assessment of MBS colonoscopy items to ensure they reflect contemporary evidence, offer improved health outcomes for patients and represent value for money. Any changes to MBS colonoscopy items will be informed by the review’s assessment of the evidence.
Consultants DLA Piper Australia (previously DLA Phillips Fox) were engaged to undertake the review, and a Clinical Working Group (CWG) was established. The role of the CWG was to provide clinical input to the consultants, and to ensure the review reflects current clinical practice in Australia, and draws valid conclusions from the evidence. The Department would like to thank the CWG members for the vital assistance provided in undertaking this review. The CWG consists of specialist gastroenterologists and surgeons nominated by:
- Gastroenterological Society of Australia;
- Royal Australasian College of Physicians;
- General Surgeons Australia;
- Conjoint Committee for Certification of Training in Gastrointestinal Endoscopy (CCCTGE);
- Royal Australasian College of Surgeons (nominated by the Colorectal Surgical Society of Australia and New Zealand); and
- Quality Working Group of the National Bowel Cancer Screening Program.
Clinical research questions were developed to address the effectiveness, cost effectiveness, safety and quality, and patient access issues with colonoscopy. The Review Report consists of a systematic literature review, and an analysis of relevant MBS and Casemix data to quantify utilisation of colonoscopy in Australia.
The MBS items included in the review are as follows:
|MBS Item No||Descriptors|
|32090||Fibreoptic colonoscopy examination of colon beyond the hepatic flexure with our without biopsy|
|32093||Endoscopic examination of the colon beyond the hepatic flexure by fibreoptic colonoscopy for the removal of 1 or more polyps, or the treatment of radiation proctitis, angiodysplasia or post-polypectomy bleeding by argon plasma coagulation|
The review has found strong evidence that colonoscopy is an effective diagnostic and therapeutic procedure. Colonoscopy prevents colorectal cancer from developing in many at-risk patients through the identification and removal of pre-malignant tumours; it assists in the identification of malignant tumours at an earlier disease stage; and it is colon-sparing in some patients with inflammatory bowel disease. The effectiveness of colonoscopy in reducing risk of neoplasia is dependent on a range of factors, including appropriate timing of the procedure. Diagnostic yield is significantly lower in asymptomatic patients who are not at increased risk of colorectal cancer.
Growth in MBS colonoscopy services rose 84% from 2000-01 to 2009-10, although this was partially offset by the decline in sigmoidoscopy and barium enema services; overall growth in large bowel investigative procedures, including colonoscopy, was 39% over the same period. Only 30% of patients had more than one colonoscopy. Growth should also be considered within context of the number of patients diagnosed with colorectal cancer in Australia, which increased 16% from 12,264 in 2000 to 14,234 in 2007.
Next stepsWhen the four-week period of public consultation has concluded, the Review Report will be refined, as necessary, and will be considered by the Medical Services Advisory Committee.
Colonoscopy Review ProtocolThe draft protocol for the Review of MBS colonoscopy items underwent a three week public consultation period, which closed on 26 November 2010.
The final review protocol for the review of MBS Colonoscopy items can be accessed below.
Review protocol - Colonoscopy (PDF 215 KB)
Review protocol - Colonoscopy (Word 415 KB)
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