Medicine

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1. Nominations​
• Autologous haematopoetic stem cell transplant (HSCT)
• Bronchial thermoplasty
• Cellular immunotherapy
• Dialyser cartridge for haemodialysis treatment
• Neurofibromatosis service
• Out of scope
2. Emerging technology updates
• ​​​Closed loop insulin pump
• MRI based treatment planning
• MRI linear accelerator
• Non-invasive cardiac output monitor​
• Orthotics laser scanner and robot carver
• Retinal Camera
• Targeted radiotherapy for prostate cancer
• Whole genome sequencing for the investigation of mitochondrial disease
• Out of scope​ 

Nominations

Autologous haematopoetic stem cell transplant (HSCT) 

In 2014, a nomination was received to establish a stem cell transplantation service for the treatment of three auto-immune diseases: severe systemic scleroderma, systemic lupus erythematosus and multiple sclerosis. The Committee considered that further advice on this technology should be sought and the nomination was referred to the former HealthPACT. 

Actions

• HealthPACT undertook an assessment of stem cell transplantation for the three indications and found:
• HSCT was an accepted treatment option for severe systemic sclerosis only
• ​the evidence for systemic lupus erythematosus and multiple sclerosis was still evolving.
• A protocol for autologous HSCT has been developed by the NSW Agency for Clinical Innovation (ACI).
• In 2016, a service was established at St Vincent’s Hospital under an evaluation framework.
• The ACI are responsible for delivery of this evaluation which is anticipated by 2020. 

Bronchial thermoplasty

In 2015, a nomination was received for the use of bronchial thermoplasty, a technology that specifically targets airway smooth muscle for radiofrequency ablation. Its proposed use is in the treatment of severe persistent asthma. In 2016, an update was submitted that provided a summary of recent evidence.

Actions

• The Committee referred this to the ACI for advice.
• Given the lack of clinical evidence and uncertainty around the long term benefits and harms of the therapy the ACI recommended that bronchial thermoplasty should only be provided in NSW under a research framework.
• The Medical Services Advisory Committee (MSAC) reviewed this technology in 2015 and did not recommend listing on the Medical Benefits Scheme (MBS) due to uncertainties with the patient population, efficacy and uncertain cost-effectiveness. Refer to Application No. 1384 - Bronchial thermoplasty for the treatment of severe persistent asthma​

Cellular immunotherapy

In 2017, a nomination was received to support the establishment of a cellular immunotherapy service. This service is proposed for the manufacture of cellular therapeutics and the treatment of patients requiring these products. 

Actions

• The Committee referred the application to the Health Technology Reference Group (HTRG) for a health technology assessment.
• NSW Health also commissioned a rapid evidence check of cellular therapies for the treatment of malignancy​
• The evidence check found considerable uncertainty around the long term benefits and risks of cellular therapies for malignancy.
• The Committee recommended that cellular therapies only be provided to patients under a research framework until more substantive evidence is available.
• The status of this technology will continue to be monitored. 

Dialyser cartridge for haemodialysis treatment

In 2017, a nomination was received for a single use dialyser for use in home renal dialysis machines. 

Actions

• The Committee sought further advice from the Agency for Clinical Innovation Renal Network.
• The network noted that there is currently little peer reviewed efficacy and safety data to support the use of the device and recommended that it not be used outside of a research framework.
• The status of this technology is being monitored.

Neurofibromatosis service

In 2017, a nomination was received to establish a new hub and spoke clinic model for the management of patients with neurofibromatosis (NF). 

​Actions

• The Committee referred this for further analysis.
• The hub and spoke service delivery model was considered important to develop and test new approaches to the delivery of genetic and genomic services.
• The project will run over four years as part of implementation of the NSW Health Genomics Strategy. 

Out of scope

Electroencephalography (EEG) and functional MRI combination for epilepsy (2015)

The Committee advised the technology was not new to the NSW public system, rather the combination of two imaging modalities.

Electronic medical record interface for ECG recordings (2015)

Considered to be an Information and Communications Technology.

Laser ablation therapy for the treatment of drug resistant epilepsy (2015)

Technology was not approved by the Therapeutic Goods Association and was unavailable in NSW at the time of application.

Wearable monitoring device for chronic disease management (2015)

The Committee advised the technology was not new to the NSW public system.

Centralised drug fridge monitoring (2016)

This technology was not a diagnostic or therapeutic technology. Referred to HealthShare.

Medical information exchange software (2017)

Considered to be an Information and Communications Technology. Referred to eHealth.

Paediatric stereotactic electroencephalography service (2016)

The Committee advised the technology was not new to the NSW public system. Requested the district raise this during annual service agreement negotiations with the Ministry.

Patient information smart phone app (2017)

Considered to be an Information and Communications Technology. Referred to eHealth.

Emerging technology updates

Closed loop insulin pump

In 2018, an update was received for a closed loop insulin pump which was the subject of a clinical trial. It is anticipated the results of the trial will be published in late 2019.

Outcomes

• research trial underway
• update requested.

MRI based treatment planning

In 2019, an update was received on the use of combined MRI images for radiotherapy treatment instead of CT images. This was included in the scope for a planned evidence review on diagnostic imaging to be completed by the Health Technology Reference Group.

Outcomes

• evidence review underway
• research trial underway
• update requested.

MRI linear accelerator

Outcomes

• evidence review underway
• research trial underway
• update requested.

​Non-invasive cardiac output monitor

In 2019, an update was received for a non-invasive hemodynamic monitor which measures cardiac output and cardiac index to assess the severity of heart failure. 

​Outcomes

• research trial underway​
• update requested.

​Orthotics laser scanner and robot carver 

In 2018, an update was received for a laser scanner and robot carver to replace traditional plaster casting. The robot has the capacity to produce orthoses for other healthcare services that have the appropriate scanner and software in place. 

​Outcomes 

• local implementation underway
• update requested. 

​Retinal camera 

In 2019, an update was received for an electroretinogram which may take digital photographs of the retina for transfer to a specialist centre to be evaluated. This could improve access for patients in rural and remote areas. 

​Outcomes 

• local implementation underway
• update requested.

​Targeted radiotherapy for prostate cancer 

In 2019, an update was received for software used on a standard linear accelerator to assess prostate position during radiotherapy for treatment of prostate cancer.  

​Outcomes 

• local implementation underway
• update requested. 

​Whole genome sequencing for the investigation of mitochondrial disease 

In 2019, an update was received on whole genome sequencing which may be used to diagnose different forms of mitochondrial disease. 

​Outcomes