Authors' recommendations: MSAC supported public funding via the proposed MBS item with the wording of the item descriptor and timing of implementation coordinated with the PBS listing of botulinum toxin type A. Draft new MBS item Category 3 – Group T11 – botulinum toxin injections New item 18379 Botulinum toxin type A (Botox), intravesical injection of, with cystoscopy, for the treatment of urinary incontinence, including all such injections on any one day, if: (a) the urinary incontinence is due to idiopathic overactive bladder in a patient: (i) who is at least 18 years of age; and (ii) the patient has urinary incontinence that has been inadequately controlled by at least two alternative anti-cholinergic agents, as manifested by having experienced at least 14 episodes of urinary incontinence per week before commencement of treatment with botulinum toxin type A; and (b) the patient is willing and able to self-catheterise; and (c) the requirements relating to botulinum toxin type A under the Pharmaceutical Benefits Scheme are complied with; and (d) treatment is not provided on the same occasion as a service described in item 104, 105, 110, 116, 119, 11900 or 11919 For each patient—applicable not more than once, except if the patient achieves at least a 50% reduction in urinary incontinence episodes from baseline at any time during the period of 6 to 12 weeks after first treatment (Anaes.) (H) MBS fee: $229.85* Benefit: 75% = $172.40 *MBS fee and benefit (rebate) are at the 1 November 2012 rate. Fee and benefit from 1 November 2014 will be at the 1 July 2014 indexed rate (e.g. $234.00 and $175.50 respectively). MSAC noted that the flow-on implications for MBS costs were large and highly uncertain and supported the Department undertaking further work to refine these estimates.

Project Status: Completed

Year Published: 2013

URL for published report: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1272-public

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Medical Services Advisory Committee

Contact Address: MSAC (MDP 107), GPO Box 9848, Canberra, ACT 2601, Australia. Tel: +61 2 6289 6811; Fax: +61 2 6289 8799.

Contact Name: msac.secretariat@health.gov.au

Contact Email: msac.secretariat@health.gov.au

Copyright: Medical Services Advisory Committee (MSAC)