scenario, HbA1c_2). However, the clinical uncertainty associated with this conclusion is significant. Financial/budgetary impacts While HbA1c testing is proposed to replace currently available tests, accurate MBS utilisation data could not be retrieved for the FPG test, as the relevant item number also lists a number of other tests. In consequence, an epidemiological approach has been undertaken for estimation of the pre-diabetic and ‘high-risk’ population (who are recommended for FPG and OGT testing, if indicated). As women with a history of gestational diabetes or polycystic ovary syndrome are recommended for regular testing with the OGT test (; ), a market-share approach is used to estimate this population. The total cost savings to the MBS for the proposed use of diagnostic HbA1c testing, using a base-case set of assumptions, averages $39 million per year for the HbA1c_1 scenario and $25 million per year for HbA1c_2, when estimates include test accuracy data. When accuracy data is not included in the estimates, the average annual net cost savings to the MBS is $39 million for the HbA1c_1 and $37 million for the HbA1c_2 scenarios. However, a number of issues are present that contribute to uncertainty in the results of the financial Uncertainties relating to the estimated population likely to be tested include the proportion of pre-diabetic patients that are undiagnosed, the uptake rates of diabetes risk assessment (given that screening is recommended opportunistically), the patient uptake of testing, and the accuracy of the comparator and intervention tests. These issues are further compounded by recommendations for repeat testing in subsequent years. Additionally, the cost of the initial FPG test is uncertain (it varies depending on whether the test is ordered alone or with other tests listed in the same item number), leading to overall uncertainty in the costs that would be offset with the introduction of HbA1c testing. When financial impact estimates are varied from the base-case in sensitivity analyses (using plausible variable limits), the estimates range widely between annual cost savings of $40 million to net costs of $11 million. Given the multiple uncertainties in the estimated population eligible for testing and other testing parameters, the financial implications to the MBS cannot be confidently estimated.
scenario, HbA1c_2). However, the clinical uncertainty associated with this conclusion is significant. Financial/budgetary impacts While HbA1c testing is proposed to replace currently available tests, accurate MBS utilisation data could not be retrieved for the FPG test, as the relevant item number also lists a number of other tests. In consequence, an epidemiological approach has been undertaken for estimation of the pre-diabetic and ‘high-risk’ population (who are recommended for FPG and OGT testing, if indicated). As women with a history of gestational diabetes or polycystic ovary syndrome are recommended for regular testing with the OGT test (; ), a market-share approach is used to estimate this population. The total cost savings to the MBS for the proposed use of diagnostic HbA1c testing, using a base-case set of assumptions, averages $39 million per year for the HbA1c_1 scenario and $25 million per year for HbA1c_2, when estimates include test accuracy data. When accuracy data is not included in the estimates, the average annual net cost savings to the MBS is $39 million for the HbA1c_1 and $37 million for the HbA1c_2 scenarios. However, a number of issues are present that contribute to uncertainty in the results of the financial Uncertainties relating to the estimated population likely to be tested include the proportion of pre-diabetic patients that are undiagnosed, the uptake rates of diabetes risk assessment (given that screening is recommended opportunistically), the patient uptake of testing, and the accuracy of the comparator and intervention tests. These issues are further compounded by recommendations for repeat testing in subsequent years. Additionally, the cost of the initial FPG test is uncertain (it varies depending on whether the test is ordered alone or with other tests listed in the same item number), leading to overall uncertainty in the costs that would be offset with the introduction of HbA1c testing. When financial impact estimates are varied from the base-case in sensitivity analyses (using plausible variable limits), the estimates range widely between annual cost savings of $40 million to net costs of $11 million. Given the multiple uncertainties in the estimated population eligible for testing and other testing parameters, the financial implications to the MBS cannot be confidently estimated.
1267-FinalContractedAssessmentReport-accessible.DOCX