To the Editor:
Thank you for the opportunity to reply to the letter by Mundy, Hiller, and Merlin “The true role of horizon scanning in Australia: Who it informs and why”. This letter states that our paper (Reference O'Malley and Jordan1) “Horizon scanning of new and emerging medical technology in Australia: Its relevance to Medical Services Advisory Committee health technology assessments and public funding,” published in July 2009, contains fundamental errors and misunderstands the process it claims to describe.
The HealthPACT Terms of Reference, current when accessed in November 2008, that formed the premise upon which our paper was based (in contrast to that quoted by Mundy et al.) included “The role of HealthPACT is to assist the introduction of new and emerging medical technologies into the public sector, with consideration to the private sector, in Australia and New Zealand through horizon scanning, including reporting on safety, effectiveness and cost implications.” This term of reference is also consistent with the statement by Brendon Kearney, the chairperson of HealthPACT that “The horizon scanning program was established under MSAC to provide advance notice of significant new and emerging technologies to health departments in Australia and New Zealand, and to exchange information and evaluate the potential impact of emerging technologies on their respective health systems” (Reference Kearney2). We assume that the Australian Government Department of Health and Ageing comes under the definition of “a health department.”
Although the Australian healthcare system, with regard to the funding of new and emerging medical technology, is a dual system (as stated in the first sentence of our paper), the stated policy of the Australian Government is that all Australians will have equal access to health services regardless of insurance status. The statement by Mundy et al. that “the majority of technologies assessed relate to the public hospital system and, therefore, do not require reimbursement through the MBS or an MSAC assessment” would appear to suggest that there are different technologies being used in the public system compared with the private system and, therefore, go through different assessment pathways. Our paper does not claim that all technology should have been assessed by MSAC but rather that any technology assessed by MSAC should have been previously identified by the horizon scanning process.
While acknowledging that the statement in our paper “all prioritizing summaries are carried out as a result of a recommendation of HealthPACT” should have read “all prioritizing summaries are carried out as a result of a prioritization by HealthPACT', we are unsure that this is crucial to the main point made in our paper.
Mundy et al. state that “there were a number of errors in the data presented” in our paper and that it would be unrealistic for an Horizon Scanning network, founded in November 2003, to assess these first ten mature technologies assessed by MSAC listed in Table 1 in our paper (MSAC applications lodged from March 2004 onward that had no prior Prioritizing Summary or Horizon Scanning Report). Despite this claim, the first technology to be subjected to horizon scanning (report dated November 2003) was capsule endoscopy. The date of this report was fifteen months after the very same technology was lodged for a (successful) full MSAC HTA in August 2002.
Mundy et al. state that “A prioritizing criterion of the ANZHSN is that technologies must be likely to emerge in the Australasian health scene within 3-years—at the point of MSAC assessment the technology has already received regulatory approval and is well established in the health system.” Despite this claim, a large number of technologies identified and assessed by the horizon scanning process are already TGA approved. It would seem that there is some confusion as to how to define “new and emerging.” This issue was addressed in our paper and used the example of the Radi coronary pressure wire that did not have an MSAC application lodged until May 2004 (positive recommendation for funding in March 2006) yet there were clinical papers dating back to 1993. We suggest that because the ANZHSN and MSAC are both concerned about funding, “new and emerging” should refer to any as yet unfunded technology.
Our paper was extensively reviewed with the reviewers' comments clearly indicating that they had an intimate knowledge of the Australian horizon scanning process. All of the reviewers' comments and recommendations were addressed and we would like to take this opportunity to thank them.
We stand by the basic contention of our paper that a medical technology submitted to MSAC, especially one that gets a positive recommendation for funding, should have been previously identified by the horizon scanning process. It should not matter that MSAC assesses technology for funding in the private sector because the Australian Government has a policy of making the same technology available in the public sector. As we move into the second half of 2010, MSAC applications are still being lodged for technologies that 3 years ago could have been identified by the horizon scanning process. For example, Application 1140: Matrix-induced Autologous Chondrocyte Implantation (MACI) and Autologous Chondrocyte Implantation (ACI), lodged May 2009.
CONFLICT OF INTEREST
Both authors report having no potential conflicts of interest.
