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					Message from the Minister                                                     October 2009

                I am pleased to present this fourth edition of Health       Inside this issue:
                technology news. The Health Technology Program now
                sits within the newly formed Department of Health.          Message from
                The recent Expression of Interest call for 2010-11          the Minister              1
                funding of new health technologies attracted a large
                                                                            Profile of the new
                number of submissions and many reflected collaboration      VPACT Chair               2
                between health services. Through this program we will
                                                                            New VPACT members         2
                continue to encourage innovation and rapid translation
                of evidence into practice.                                  New Technology Program
                                                                            2010-11 funding        3
In August, Southern Health, supported by the department, presented          Funding submission
a workshop on ‘disinvestment’ – or removing outdated or ineffective         timelines                 3
practices and health technologies. It is pleasing to report that this       Health Technologies
meeting (the first of its kind in Australia) attracted participants from    funded in 2009-10         3
across Australia and New Zealand. Southern Health is funded to              Health Technologies
investigate local opportunities for disinvestment, and outcomes will        to commence funding
be of interest to government and other health services alike.               in 2009-10                4
                                                                            HealthPACT update         4
Also in August, I announced a $1.2 million investment in laser
technology to assist health services treat prostate disease. The            Health Technology
                                                                            Assessment review
department’s Health Technology and Statewide Surgical Services              update                    4
Programs are collaborating to fund this technology. This should
                                                                            Sg2 presentation          5
have a significant impact on waiting lists and patient outcomes.
It is an excellent example of different parts of the department             Sustainability in Healthcare
working together to improve people's lives.                                 by Allocating Resources
                                                                            Effectively (SHARE)
                                                                            Program workshop          5
Victoria continues to provide support to other jurisdictions as they
develop processes and mechanisms to support decision-making and             Nationally Funded
                                                                            Centres update            5
funding around the appropriate introduction of new health technology.
The recent establishment of QPACT in Queensland heralds an exciting         Tiny teen a transplant
                                                                            first                     6
development in inter-jurisdictional cooperation and should lead
to sharing of information about, and coordination of activities related     Links to recent media
to, health technology uptake.                                               events                    6
                                                                            Health Technology
I would like to take this opportunity to introduce the new Chair of the     Assessment Agency
Victorian Policy Advisory Committee on Technology (VPACT), Associate        profile                   7
Professor Richard King. Richard is a well-respected physician with a long   Useful links              8
pedigree in health technology assessment and uptake. I look forward         Contact details           8
to Richard’s contribution to VPACT and to seeing his vision unfold
for Victoria’s Health Technology Program.

Hon Daniel Andrews MP
Minister for Health




 www.health.vic.gov.au/newtech
 Department of Health                            1
Victorian Policy Advisory                                 Profile on the VPACT Chair, Richard
Committee on Technology (VPACT)                           King
Committee members                                                          Richard King is the Program
                                                                           Medical Director for Medicine,
VPACT members           Affiliation
                                                                           Diagnostic Imaging and
Associate Professor     VPACT Chair, Program                               Pathology at Southern Health.
Richard King            Director for Medicine and
                        Diagnostic Imaging and
                                                                           Richard is a general physician,
                        Pathology, Southern Health                         gastroenterologist by training.
Ms Sophy Athan          Consumer representative                            Richard:
Ms Liliana Bulfone      Senior Research Fellow,
                        School of Health and
                                                          •   is a member of Health Technology
                        Service Development,                  Assessment International (HTAi) and is
                        Deakin University                     on HTAi’s special interest groups in relation
Professor Rob Carter    Chair in Health and Human             to disinvestment and hospital-based health
                        Services Economics, Deakin            technology assessment
                        University
Professor Chris         University of Melbourne           •   has been a member of the Medical Benefits
Christophi              Department of Surgery,                Advisory Committee, which was the
                        Austin Hospital. Chair New
                        Technology Committee                  forerunner to MSAC (Medical Services
                        Austin Health                         Advisory Committee) for the
Associate Professor     Executive Director, Medical           Commonwealth Department of Health,
Caroline Clarke         Services, Royal Childrens             and was on MSAC for six years
                        Hospital
                                                          •   set up the first health service New
Associate Professor     Director of Australian
Noel Cranswick          Paediatric Research Unit,             Technology Committee in Victoria in 2001,
                        Royal Children’s Hospital             and has been instrumental in setting up the
Associate Professor     Director, Department of               disinvestment (SHARE) Program
Paul Desmond            Gastroenterology & Clinical           at Southern Health
                        Director, Specialist & Critical
                        Care, St Vincent’s Hospital       •   has been a member of the Review
Mr Steven Fitzpatrick   Director Management
                                                              Committee of the Commonwealth
                        Accounting, Alfred Health             Department of Health and Ageing Enquiry
Associate Professor     Director, Research                    of Medical Assessment.
Richard Gerraty         Education & Stroke Service,       We look forward to the expertise Richard will
                        The Alfred
                                                          bring to VPACT in his role as Chair.
Associate Professor     Director of Research,
Stacy Goergen           Department of Diagnostic
                        Imaging, MMC                      New VPACT members
Dr Jennifer Johns       Medical Director, Specialty       The Department of Health is delighted to have
                        Services CSU, Austin
                                                          five new VPACT members and a new Chair.
                        Hospital
                                                          The new members are:
Professor Ken           Director of Radiology, The
Thompson                Alfred. Member of MSAC
                        and the Medical Device            •   Associate Professor Richard King (Chair),
                        Incident Review Panel of              Southern Health
                        TGA
Professor Ingrid        Executive Director of
                                                          •   Professor Chris Christophi, Austin Health
Winship                 Research & Chair in Adult         •   Professor Ken Thompson, Alfred Health
                        Clinical Genetics, Melbourne
                        Health                            •   Professor Ingrid Winship, Melbourne Health
Dr Gavin Wright         Thoracic Surgeon, St
                        Vincent’s Hospital and Peter      •   Mr Steven Fitzpatrick, Alfred Health
                        MacCallum Cancer Centre
                                                          •   Associate Professor Caroline Clarke, Royal
Professor John          Chief Medical Officer &
Zalcberg                Director, Division of                 Childrens Hospital
                        Haematology & Medical
                                                          •   Dr Gavin Wright, St Vincent’s and Peter
                        Oncology, Peter McCallum
                        Cancer Centre                         MacCallum Cancer Centre
                                                          We welcome all new members, and look
                                                          forward to their valuable input into VPACT.


 www.health.vic.gov.au/newtech
                                                          2
 Department of Health
   New Technology Program 2010-11                     Health Technologies funded
   Funding                                            in 2009-10
   A new step in the 2010-11 New Technology           The New Technology Program is continuing
   Program funding submission process has been        to fund the following health technologies
   implemented. The new process will streamline       in 2009-10:
   the process and involves health services
   providing Expressions of Interest. These have      New Technology item        Health service
   been evaluated, with short-listed Expressions
   of Interest being developed into full business     MRI for diagnosis of       The Alfred
   cases for consideration by VPACT.                  cardiac pathology

   Short-listed technologies being developed into     MRI for 2nd trimester      Monash Medical
   full business cases are:                           fetal diagnosis            Centre

   •   Confocal Endomicroscopy for real time          Bone anchored hearing      Royal Victorian Eye
       microscopic imaging of the gastrointestinal    aids for ear canal         and Ear Hospital/The
       mucosa                                         atresia and chronic        Alfred
                                                      middle/outer ear
   •   Capillary Array Sequencer for sequencing
                                                      disease
       of DNA samples
   •   Continuous Glucose Monitoring for real time    Paediatric dystonia for    Royal Children’s
       glucose monitoring for selected adult          complex movement           Hospital
       patients with type 1 diabetes mellitus         disorders
   •   Intraoperative O-arm Navigation
       for intraoperative multiplanar three-          Percutaneous               Monash Medical
                                                      sclerotherapy for          Centre
       dimensional anatomy imaging
                                                      peripheral AVMs
   •   Low Frequency Ultrasound Debridement
       for debridement of chronic leg ulcers          Endobronchial              Austin Hospital
   •   Robotic Seed Low Dose Rate Brachytherapy       ultrasound-guided FNA
       for prostate cancer                            for lung cancer staging
   •   Sinuplasty for treating frontal sinusitis
                                                      MRI-guided ultrasound      Royal Women’s
   •   Sir-Spheres for inoperable liver tumors        for treatment of           Hospital
   •   Spyglass direct cholangioscopy for bile duct   uterine fibroids
       diagnosis and therapy
                                                      320-slice cardiac CT for   Monash Medical
   The department has received positive feedback
                                                      diagnosis and              Centre
   regarding the new process and we hope the          monitoring of coronary
   process will lead to further engagement with       and congenital heart
   clinicians and more collaboration between          disease
   health services.
                                                      Rapid determination of     Peter MacCallum
   2010-11 New Technology Program                     BRCA 1 & 2 status          Cancer Centre/Royal
                                                                                 Melbourne Hospital
   funding submission timelines
   Action                      Date                   LDL apheresis for          Austin Hospital
                                                      homozygous FH
   Deadline for Full          11 December 2009
   Submission
                                                      RF HALO Ablation for       St Vincent’s
   VPACT                   16 February 2010           Barrett’s Oesophagus       Hospital/Royal
   recommendations of full                                                       Melbourne Hospital
   submissions
   DoH funding decisions      March 2010
   Implementation             1 July 2010




www.health.vic.gov.au/newtech
                                                      3
Department of Health
   Health Technologies to commence                       •   Percutaneous aortic valve replacement –
   funding in 2009-10                                        although not registered by TGA, continue
                                                             to monitor, noting need to survey existing
   New Technology item           Health service
                                                             activity across Australia.
   Greenlight laser for benign   Southern Health         •   Implantable gastric stimulator for morbid
   prostatic hypertrophy                                     obesity - do not progress since no evidence
                                                             of significant weight loss.
   Fibroscan for assessing       Alfred, Austin,
   liver disease                 Southern, St
                                                         Links to all HealthPACT reports and decisions
                                 Vincent’s Health        are available through the horizon scanning
                                                         website at www.horizonscanning.gov.au.
   Liquid chromatography/        Alfred Health
   tandem mass spectrometry                              Other HealthPACT items to note include:
   for measurement of
   immunosuppressive                                     •   An assessment of Image Guided Radiation
   agents in transplant                                      Therapy (IGRT) and Intensity-Modulated
   patients                                                  Radiation Therapy (IMRT) is currently
                                                             underway.
   Free Light Chain High Cut     St Vincent’s,
   Off protein analysis          Austin,                 •   A planning session considered the following:
   membranes                     Southern, Royal             o   2009-10 work plan
                                 Melbourne,
                                                             o   revised terms of reference reflecting
                                 Barwon and
                                 Alfred Health                   revised governance of HealthPACT
                                                             o   information presented in and priority
   Direct Diaphragmatic          Austin Health                   setting of Prioritising Summaries
   Pacing for chronic
   ventilatory failure                                       o   coordination of HTA activities across
                                                                 Australia.
   Gated radiotherapy for        Alfred Health           •   Professor Brendon Kearney from SA has
   breast and lung cancer                                    been reappointed Chair of HealthPACT.

                                                         HTA review update
   HealthPACT update
                                                         The Commonwealth review of Health
   At its August meeting, HealthPACT reviewed            Technology Assessment (HTA) processes
   the following new or emerging health                  continues. The review examines the processes
   technologies and made the associated                  and relationships between the Medical Services
   decisions:                                            Advisory Committee (MSAC), Pharmaceutical
                                                         Benefits Advisory Committee (PBAC),
   •   Dynamic wound closure system – monitor
                                                         Therapeutic Goods Administration (TGA),
       over 12 months.
                                                         and the Prosthesis and Devices Committee.
   •   Single incision laparoscopic surgery for
       cholecystectomy – monitor over 12 months          The call for submissions for the review closed
       noting the lack of safety data.                   at the end of May 2009. There were 86
   •   Minimally-invasive robot-assisted                 submissions received, many of which were
       unicompartmental knee arthroplasty –              quite detailed. As part of the ‘issues
       do not progress as no evidence that better        identification phase’ of the review, nine
       alignment translates into improved patient        stakeholder focus groups were conducted
       outcomes.                                         and 14-15 bilateral meetings were held with
   •   Intra-abdominal vagal blocking for obesity –      peak stakeholder bodies. The review is now
       do not progress due to lack of evidence.          moving into an ‘options development phase’.
   •   Mini-cardiopulmonary bypass system – do           Further information is available at
       not progress as not registered with TGA.          www.health.gov.au/htareview.
   •   Pumpless extracorporeal interventional lung
       assist (iLA) system – assessment of ECMO
       devices under consideration.




www.health.vic.gov.au/newtech
                                                     4
Department of Health
   Sg2 Presentation                                                   The day began with a presentation from Adam
                                                                      Elshaug and Janet Hiller from the University
   A presentation on selected technologies will
                                                                      of Adelaide who gave us an interesting look
   be held by Sg2, an international health care
                                                                      at disinvestment from a policy perspective.
   research and consulting company, with clinical
                                                                      Following this, a health economics perspective
   and technical expertise in new technologies.
                                                                      was presented by Duncan Mortimer and
   See www.sg2.com for further information                            Anthony Harris from the Centre of Health
   on Sg2.                                                            Economics at Monash University. The day
                                                                      concluded with Claire Harris and Ian Larmour
   Sg2's imaging expert will be giving                                from Southern Health who gave us a local
   a presentation on Operating Theatre                                health services perspective based on work
   imaging, which will cover:                                         accomplished as part of the SHARE program
                                                                      and the Therapeutics Equivalence program
   •    Intraoperative O-Arm Navigation system                        and Southern Health.
   •    Confocal Endomicroscopy
                                                                      The workshop was very successful and
   •    Spyglass direct cholangioscopy                                attracted over 70 participants from Victoria,
                                                                      interstate and New Zealand. Government,
   The presentation will be held on 11 November
                                                                      health services, academic and research groups,
   between 9.00am and 10.30am at the
                                                                      professional associations and consumers were
   department.
                                                                      all represented. Feedback has been positive
   If you would like to attend, further details can                   and attendees have suggested establishing
   be found on the new technology website,                            a national annual forum on disinvestment.
   www.helath.vic.gov.au/newtech.                                     A report of the workshop, along with slides
                                                                      of the presentation will be made available
                                                                      on the New Technology website shortly.
   Sustainability in Healthcare by                                    For more information please contact Luisa
   Allocating Resources Effectively                                   Chaves at luisa.chaves@dhs.vic.gov.au
   (SHARE) Program
   Health Technology disinvestment: tests, drugs,                     Nationally Funded Centres (NFC)
   clinical practice                                                  update
                                                                      Assessment is underway for the following three
                                                                      procedures, which have been proposed as new
                                                                      NFC Programs:

                                                                      •   Paediatric Lung Transplantation
                                                                      •   Norwood procedure for Hypoplastic Left
                                                                          Heart Syndrome
                                                                      •   Peritonectomy plus hyperthemic
                                                                          intraperitoneal chemotherapy for
                                                                          pseudomyxoma peritoneii and peritoneal
                                                                          mesothelioma.
       At the recent SHARE Program workshop, L-R Dr Adam
       Elshaug, Adelaide University, Assoc Prof Richard King,
                                                                      The following Victorian NFC Programs have
       Southern Health, Prof Janet Hiller, Adelaide University.       estimated they will undertake the indicated
                                                                      activity in 2009-10:
   On 27 August 2009, a workshop was held
   at the Royal Australasian College of Surgeons                      •   Paediatric Heart Transplantation (RCH): six
   to consider ‘disinvestment’ in health                                  procedures (three with and three without
   technology. This workshop was hosted                                   Ventricular Assist Devices)
   by Southern Health, in conjunction with the                        •   Paediatric Liver Transplantation (RCH):
   Department of Health as a part of the SHARE                            12 procedures
   program. The aim of the workshop was                               •   Pancreas Transplantation (MMC):
   to consider how we might remove outdated                               12 procedures
   or ineffective practices and health technologies
   from practice.                                                     Further information about NFC Programs
                                                                      is at www.health.vic.gov.au/newtech.

www.health.vic.gov.au/newtech
Department of Health
                                                                  5
   Tiny teen a transplant first                           He said Brooke, who is the ninth child to
                                                          undergo a paediatric lung transplant at The
   (Article from health Victoria)
                                                          Alfred since the program’s establishment in
   Weighing in at just over 22 kilos and standing         2005 in collaboration with the Royal Children’s
   a mere 132 centimetres, Brooke Howe, 13 is             Hospital, had responded extremely well.
   believed to be the smallest and lightest patient
   to undergo a lung transplant in Australia.

   The diminutive patient, who makes up for her
   small frame with a big personality, recently
   underwent a double lung transplant at the
   Alfred Hospital.

   Brooke, who suffers from Cystic Fibrosis,
   was placed on The Alfred’s lung transplant
   list earlier this year.

   Initially, Brooke thought she might have
   to wait a year or more for the possibility
   of a transplant.

   But, in a rare stroke of luck, Brooke received
   organs from a young donor only days later.

   With a growing reputation for excellence in
   paediatric lung transplantation, The Alfred
   is the only facility in the country equipped
   with the expertise and resources to support
   a patient like Brooke.

   Paediatric Lung Transplant Consultant Glen
   Westall said while her size presented some
   challenges in terms of the surgery, the on-
   going care for a young patient like Brooke
                                                          Recipient Brooke Howe and her Paediatric Lung Transplant
   remained extremely complex.
                                                          Consultant Glen Westall at The Alfred.

   ‘Everything from medication doses and                  Almost immediately after her surgery, Brooke
   anaesthesia levels to the provision of a               noticed a big difference in the range of things
   stimulating rehabilitation program for a young         that she could do and is enjoying the simple
   person needs to be taken into account,’ Dr             things like walking without the aid of oxygen
   Westall said.                                          and brushing her hair.
   ‘For a hospital used to treating adults, this          The vivacious Sydney teenager is looking
   presents its own set of unique challenges.’            forward to playing netball and hanging out with
                                                          her friends.
   Dr Westall said with support from Ronald
   McDonald House Charities, several Alfred staff
   have travelled to some of the leading paediatric       Links to recent media events
   lung transplant centres in the United States           •   Groundbreaking surgery gives hope
   and the United Kingdom in recent years to help             to quadriplegic (ABC News Victoria)
   establish this highly-specialised program.                 www.abc.net.au/news/stories/2009/10/27/
                                                              2725818.htm




www.health.vic.gov.au/newtech
Department of Health
                                                      6
   Health Technology Assessment                          Recent publications include:
   (HTA) Agency Profile                                  •   Radioimmunotherapies for Non-Hodgkin
                              The Canadian                   Lymphoma: Systematic Review of Clinical
                              Agency for Drugs               Effectiveness, Cost Effectiveness and
                              and Technologies               Guidelines
                              in Health (CADTH)
                              is an independent,         •   Computed Tomography for Paediatric
                              not-for-profit                 Patients: Review of Clinical Effectiveness
                              organisation funded            and Indications for Use
   by Canadian federal, provincial and territorial
   governments to provide Canadian health care           •   Fecal Immunochemical Tests for Colorectal
   policy managers with evidence-based                       Cancer Screening: A Systematic Review of
   information on emerging and existing medical              Accuracy and Compliance
   devices. The agency was founded in 1989 and
                                                         •   Laparoscopic Diaphragm Pacing for
   has since been a leader in the area of HTA.
                                                             Tetraplegia
   CADTH supports decision makers determine
                                                         •   TomoTherapy, Gamma Knife, and
   which technologies should be used to achieve
                                                             CyberKnife Therapies for Patients with
   the best outcomes for both patients and the
                                                             Tumours of the Lung, Central Nervous
   health care system.
                                                             System, or Intra-abdomen: A Systematic
   CADTH’s program not only provides impartial,              Review of Clinical Effectiveness and Cost-
   rigorous, evidence-based reviews of clinical              Effectiveness
   and cost effectiveness but also considers the
                                                         •   Technologies to Reduce Errors in Dispensing
   broader impact of drugs and health
                                                             and Administration of Medication in
   technologies into the Canadian health system.
                                                             Hospitals: Clinical and Economic Analyses
   The HTA process examines technologies at all
   stages of their life cycles, from development         •   Endobronchial Ultrasound for Lung Cancer
   through to maturity and obsolescence. Topics              Diagnosis and Staging: A Review of the
   for assessment can be proposed by anyone                  Clinical and Cost Effectiveness
   through the CADTH website and are prioritised
   with the help of CADTH’s Advisory Committee           •   Health Technology Update Issue 11
   on Pharmaceuticals and the Devices and
   Systems Advisory Committee.                           •   Anti-TNF-a Drugs for Refractory
                                                             Inflammatory Bowel Disease: Clinical-and
   CADTH introduced the Health Technology                    Cost-Effectiveness Analyses
   Inquiry Service (HTIS) in 2005 to provide
   Canadian health care decision makers with             •   Dabigatran or Rivaroxaban Verses Other
   access to available health technology                     Anticoagulants for Thromboprophylaxis
   information based on the best available                   After Major Orthopedic Surgery: Systematic
   evidence, in a quick and efficient manner.                Review of Comparative Clinical-
   CADTH also publishes a regular newsletter                 Effectiveness and Safety
   on new and emerging health technologies.
                                                         For more information, including publications,
   CADTH is recognised as a world leader in HTA          please visit CADTH’s website at www.cadth.ca
   and works closely with agencies nationally
   and internationally.




www.health.vic.gov.au/newtech
                                                     7
Department of Health
   Useful links                                           Europe
   Australia                                              •   National Institute for Health and Clinical
   •   Australia and New Zealand Horizon                      Excellence (UK) www.nice.org.uk
       Scanning Network                                   •   National Institute for Health Research
       www.horizonscanning.gov.au                             Health Technology Assessment programme
   •   Australian Safety and Efficiency Register of           (UK) www.ncchta.org
       New Interventional Procedures – Surgical           •   EuroScan (European Consortium)
       (Royal Australasian College of Surgeons)               www.euroscan.bham.ac.uk
       www.surgeons.org/asernip-s/                        •   Cochrane Library
   •   Medical Services Advisory Committee                    www.thecochranelibrary.org
       www.msac.gov.au
   •   Adelaide Health Technology Assessment
       www.adelaide.edu.au/ahta                           Contact details
   North America                                          For information and advice about the New
                                                          Technology Program, Health Technology
   •   Canadian Agency for Drugs and                      Strategy or other related areas, please contact
       Technologies in Health                             one of the following in the department’s
       www.cadth.ca/index.php/en/home                     Genetics & Health Technology Unit:
   •   Health Technology Evaluation and
       Assessment in Ontario                              Dr Paul Fennessy
       www.health.gov.on.ca/english/providers/pr          Manager, Genetics & Health Technology
       ogram/mas/mas_mn.html                              Phone: 9096 2142
   •   Health Technology Assessment International         Mobile: 0429 019 289
       (HTAi) www.htai.org                                email: paul.fennessy@dhs.vic.gov.au
   •   Evidence-based Practice Centres / Agency
       for Healthcare Research and Quality                Ms Siegi Schmidmaier
       www.ahrq.gov/clinic/techix.htm                     Senior Project Officer
   •   BlueCross BlueShield Technology Evaluation         Phone: 9096 1296
       Center www.bcbs.com/blueresources/tec              email: siegi.schmidmaier@dhs.vic.gov.au
                                                          Ms Luisa Chaves
                                                          Project Officer
                                                          Phone: 9096 1410
                                                          email: luisa.chaves@dhs.vic.gov.au




   Accessibility
   If you would like to receive this publication in an accessible format,
   please phone (03) 9096 1327 using the National Relay Service 13 36 77
   if required, or email shaun.brown@dhs.vic.gov.au.

   This document is also available in PDF format on the internet at
   www.health.vic.gov.au/newtech.




www.health.vic.gov.au/newtech
                                                      8
Department of Health

				
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