Table 36 Method used to identify the type of analysis Comparative effectiveness versus comparator Superior Non-inferior Inferior Net clinical CEA/CUA benefit Superior CEA/CUA CEA/CUA Neutral CEA/CUA* benefit versus Net harms None^ CEA/CUA CEA/CUA* None^ safety Net comparator clinical CEA/CUA benefit Inferior None^ None^ Comparative Neutral CEA/CUA* benefit Net harms None^ Abbreviations: CEA = cost-effectiveness analysis; CUA = cost-utility analysis * May be reduced to cost-minimisation analysis. Cost-minimisation analysis should only be presented when the proposed service has been indisputably demonstrated to be no worse than its main comparator(s) in terms of both effectiveness and safety, so the difference between the service and the appropriate comparator can be reduced to a comparison of costs. In most cases, there will be some uncertainty around such a conclusion (i.e., the conclusion is often not indisputable). Therefore, when an assessment concludes that an intervention was no worse than a comparator, an assessment of the uncertainty around this conclusion should be provided by presentation of and/or cost-utility analyses. ^ No economic evaluation needs to be presented; MSAC is unlikely to recommend government subsidy of this intervention Population The current assessment is for SBE for obscure GI bleeding. The assessment has not been restricted by age group for either the proposed intervention or the comparator of DBE. This is consistent with MSAC Assessment 1102 (2006) which assessed the safety, effectiveness and cost-effectiveness of DBE for obscure GI bleeding or suspected small bowel disease relative to laparotomy with or without intra-operative enteroscopy. MSAC Assessment 1102 did not restrict by the age of the patient. Current literature indicates that there are limited studies on DBE in children which describe the procedure as safe and clinically useful, but these are mostly retrospective and include relatively small numbers. In 2012-13, Medicare statistics for items 30680 to 30684 show nil services for the 0 to 4 age group with only one claim under item 30682 for the 5-14 year age group. Figure 2 andFigure show the age breakdown of services for item 30680 (DBE oral 3 approach) and item 30682 (DBE anal approach) in 2012-13.
Table 36 Method used to identify the type of analysis Comparative effectiveness versus comparator Superior Non-inferior Inferior Comparative safety versus comparator Superior CEA/CUA CEA/CUA Net clinical benefit CEA/CUA Neutral benefit CEA/CUA* Net harms None^ CEA/CUA CEA/CUA* None^ Inferior Net clinical benefit CEA/CUA None^ None^ Neutral benefit CEA/CUA* Net harms None^ Abbreviations: CEA = cost-effectiveness analysis; CUA = cost-utility analysis * May be reduced to cost-minimisation analysis. Cost-minimisation analysis should only be presented when the proposed service has been indisputably demonstrated to be no worse than its main comparator(s) in terms of both effectiveness and safety, so the difference between the service and the appropriate comparator can be reduced to a comparison of costs. In most cases, there will be some uncertainty around such a conclusion (i.e., the conclusion is often not indisputable). Therefore, when an assessment concludes that an intervention was no worse than a comparator, an assessment of the uncertainty around this conclusion should be provided by presentation of and/or cost-utility analyses. ^ No economic evaluation needs to be presented; MSAC is unlikely to recommend government subsidy of this intervention Population The current assessment is for SBE for obscure GI bleeding. The assessment has not been restricted by age group for either the proposed intervention or the comparator of DBE. This is consistent with MSAC Assessment 1102 (2006) which assessed the safety, effectiveness and cost-effectiveness of DBE for obscure GI bleeding or suspected small bowel disease relative to laparotomy with or without intra-operative enteroscopy. MSAC Assessment 1102 did not restrict by the age of the patient. Current literature indicates that there are limited studies on DBE in children which describe the procedure as safe and clinically useful, but these are mostly retrospective and include relatively small numbers. In 2012-13, Medicare statistics for items 30680 to 30684 show nil services for the 0 to 4 age group with only one claim under item 30682 for the 5-14 year age group. Figure 2 andFigure 3 show the age breakdown of services for item 30680 (DBE oral approach) and item 30682 (DBE anal approach) in 2012-13.
1206-SBE-AssessmentReport-accessible%20(D14-1941185).docx