In the context of the Medical Services Advisory Committee (MSAC), a co-dependent technology is a medical technology/service that relies on another technology to achieve its intended purpose or enhance its effect.
A co-dependency occurs when use of one health technology/service (e.g. a medicine, or medical device or procedure) directly improves health outcomes by adding another health technology (e.g. a diagnostic pathology or imaging technology), which more accurately identifies patient subsets most likely to gain from the therapy (or monitor therapy response).
There are a number of different scenarios for possible co-dependencies that involve medical services:
Therapeutic medical service + investigative medical service (both requiring funding approval through MSAC)Investigative medical service (funding approval through MSAC) + therapeutic pharmaceutical (funding approval through the Pharmaceutical Benefits Advisory Committee (PBAC)Consultative medical service (funding approval through MSAC) + therapeutic pharmaceutical (funding approval through PBAC)
What is a Hybrid Technology?Hybrid technologies combine different characteristics of different health technologies within a single product. Common examples of hybrid technologies are drug eluting stents or photodynamic therapy for treating skin diseases.
Co-dependent ApplicationA co-dependent application occurs where one or both health technologies (that make up a co-dependent or hybrid technology) require consideration for public funding.
A co-dependent application is required when MSAC's consideration of a medical service or technology relies on information from a co-dependent drug or implantable device that PBAC or the Prostheses List Advisory Committee (PLAC) respectively must also consider.
Applicants undertaking a co-dependent application must lodge a submission-based assessment report at the appropriate stage, as they have access to information not available to Health Technology Assessment (HTA) groups (such as commercial-in-confidence data). Co-dependent submissions are lodged to PBAC and MSAC separately.
MSAC/PBAC Co-dependent ApplicationCo-dependent applications involve different governance arrangements and timing. MSAC’s PICO Advisory Sub-Committee (PASC) timeframes for co-dependent applications are the same as for non co-dependent applications - however, timeframes will differ at the Evaluation Sub-Committee (ESC) and main MSAC committee stages of the MSAC process. Information on PBAC processes (including meetings) is available on the PBS website.
Applicants are encouraged to review the guidelines for preparing assessment reports and other associated templates on this website before lodging a submission-based assessment report to MSAC. Some core information about the co-dependent therapy will need to be provided in order to link the clinical conclusion of the investigative medical service to an economic analysis.
MSAC/PLAC co-dependent applications currently have no formal alignment. PLAC's role is to determine a reimbursement price for devices funded by private health insurers (consequently, the application processes are separate). Devices will not be listed on the Prostheses List until there is a corresponding MBS item for the associated medical service.