An assessment of nucleic acid amplification testing for active mycobacterial infection
MBS fees associated with TB listing
- Bu səhifədəki naviqasiya:
- NAAT for NTM
- Uncertainty scenarios
| MBS fees associated with TB listing:
|
$2,442,440 |
$2,554,500 |
$2,666,430 |
$2,778,490 | |
|
$2,890,420 | |||||
|
MBS benefits payable (85%) |
$2,076,074 |
$2,171,325 |
$2,266,466 |
$2,361,717 |
$2,456,857 |
|
Patient co-payments a |
$144,715 |
$151,354 |
$157,986 |
$164,626 |
$171,257 |
a Only payable by patients who are not bulk-billed
NAAT = nucleic acid amplification test; TB = tuberculosis
NAAT for NTM
The cost per NTM NAAT is assumed as per the Victorian Mycobacterium Reference Laboratory cost for M. ulcerans ($50). Sensitivity analysis will be conducted using the generic region Mycobacterium PCR test cost ($120) (also from the Victorian reference laboratory). Bulk-billing rates are assumed as per NAAT for TB.
Patients eligible for NAAT for NTM include those initially suspected of an NTM infection (i.e. 50% of all patients suspected of a mycobacterial infection) and those initially suspected of TB, who may also receive testing for NTM (30% of initial TB suspects). In year 1, 24,400 patients are considered eligible for NAAT for NTM, increasing to 28,900 in year 5.
The total MBS fees associated with the introduction of NAAT for NTM increase from $1.2 million to $1.4 million over the 5-year period, of which $1.0 million in year 1 to $1.2 million in year 5 are paid by the MBS. Safety net effects to the MBS have not been considered in these calculations. Patient contributions are estimated to increase from $72,400 to $85,600 over the 5 years.
Table Number of patients eligible and cost of NAAT for NTM
|
- |
2015 |
2016 |
2017 |
2018 |
2019 |
|
Projected no. of patients eligible for NAAT |
37,575 |
39,299 |
41,022 |
42,745 |
44,468 |
|
Population suspected of NTM |
- |
- |
- |
- |
- |
|
Proportion of patients suspected of NTM |
50% |
50% |
50% |
50% |
50% |
|
Number of patients suspected of NTM |
18,788 |
19,650 |
20,511 |
21,373 |
22,234 |
|
Proportion of initial TB suspects tested |
30% |
30% |
30% |
30% |
30% |
|
Number of initial TB suspects tested |
5,636 |
5,895 |
6,153 |
6,412 |
6,670 |
|
Total no. of patients tested for NTM |
24,424 |
25,545 |
26,664 |
27,785 |
28,904 |
|
Proposed NAAT fee: |
$50.00 |
$50.00 |
$50.00 |
$50.00 |
$50.00 |
|
MBS benefit (85%) |
$42.50 |
$42.50 |
$42.50 |
$42.50 |
$42.50 |
|
Patient contribution (15%) |
$7.50 |
$7.50 |
$7.50 |
$7.50 |
$7.50 |
|
Proportion of patients bulk-billed |
61% |
61% |
61% |
61% |
61% |
|
MBS fees associated with NTM listing: |
$1,221,220 |
$1,277,250 |
$1,333,215 |
$1,389,245 |
$1,445,210 |
|
MBS benefits payable (85%) |
$1,038,037 |
$1,085,663 |
$1,133,233 |
$1,180,858 |
$1,228,429 |
|
Patient co-payments a |
$72,357 |
$75,677 |
$78,993 |
$82,313 |
$85,629 |
a Only payable by patients who are not bulk-billed
NAAT = nucleic acid amplification test; NTM = non-tuberculous mycobacteria; TB = tuberculosis
The total MBS fees associated with the introduction of NAAT increase from $3.7 million to $4.3 million over the 5-year period, of which $3.1 million in year 1 to $3.7 million in year 5 are paid by the MBS. Patient contributions are estimated to increase from $217,000 to $257,000 over the 5 years (Table 69).
Table Total cost of NAAT for requested listings
|
- |
2015 |
2016 |
2017 |
2018 |
2019 |
|
MBS fees associated with NAAT listings: |
$3,663,660 |
$3,831,750 |
$3,999,645 |
$4,167,735 |
$4,335,630 |
|
MBS benefits payable (85%) |
$3,114,111 |
$3,256,988 |
$3,399,698 |
$3,542,575 |
$3,685,286 |
|
Patient co-payments a |
$217,072 |
$227,031 |
$236,979 |
$246,938 |
$256,886 |
a Only payable by patients who are not bulk-billed
NAAT = nucleic acid amplification test
As described, the approach used to estimate the population suspected of having a mycobacterial infection may overestimate the population eligible for NAAT, as current MBS item numbers do not restrict testing to those with the clinical signs and symptoms of a mycobacterial infection.
As the implications of the Medicare Safety Net were not included in the analysis, the MBS benefits payable could be underestimated.
Uncertainty scenarios
Uncertainties flagged around estimates used in the financial analysis were tested in sensitivity analyses (Table ).
The analyses were most sensitive to increases in the NAAT cost (TB or NTM), increasing the total cost of NAAT by more than 60%. The assumption that 25% of all patients currently tested are not eligible for NAAT (e.g. those who do not have clinical signs and symptoms of mycobacterial infection) decreased the total cost of NAAT by the same proportion (25%). Changes to variables that increased the proportion of patients tested for TB (relative to NTM), and increases in the proportion of patients initially suspected of TB tested for NTM, increased the total cost of NAAT slightly (16% and 3%, respectively).
Table Sensitivity analyses
|
- |
2015 |
2016 |
2017 |
2018 |
2019 |
|
Base-case |
- |
- |
- |
- |
- |
|
Total cost of NAAT for TB |
$2,442,440 |
$2,554,500 |
$2,666,430 |
$2,778,490 |
$2,890,420 |
|
Total cost of NAAT for NTM |
$1,221,220 |
$1,277,250 |
$1,333,215 |
$1,389,245 |
$1,445,210 |
|
Total cost of NAAT |
$3,663,660 |
$3,831,750 |
$3,999,645 |
$4,167,735 |
$4,335,630 |
|
Patients eligible for NAAT, 75% (base-case: 100%) |
- |
- |
- |
- |
- |
|
Total cost of NAAT for TB |
$1,831,830 |
$1,915,810 |
$1,999,920 |
$2,083,900 |
$2,167,880 |
|
Total cost of NAAT for NTM |
$915,915 |
$957,905 |
$999,960 |
$1,041,950 |
$1,083,940 |
|
Total cost of NAAT |
$2,747,745 |
$2,873,715 |
$2,999,880 |
$3,125,850 |
$3,251,820 |
|
Proportion of patients suspected of TB, 75% (base-case: 50%) |
- |
- |
- |
- |
- |
|
Total cost of NAAT for TB |
$3,663,530 |
$3,831,620 |
$3,999,710 |
$4,167,670 |
$4,335,630 |
|
Total cost of NAAT for NTM |
$892,415 |
$933,360 |
$974,305 |
$1,015,185 |
$1,056,115 |
|
Total cost of NAAT |
$4,555,945 |
$4,764,980 |
$4,974,015 |
$5,182,855 |
$5,391,745 |
|
Proportion of patients suspected of TB, 25% (base-case: 50%) |
- |
- |
- |
- |
- |
|
Total cost of NAAT for TB |
$1,221,220 |
$1,277,250 |
$1,333,280 |
$1,389,180 |
$1,445,210 |
|
Total cost of NAAT for NTM |
$1,549,960 |
$1,621,075 |
$1,692,190 |
$1,763,240 |
$1,834,305 |
|
Total cost of NAAT |
$2,771,180 |
$2,898,325 |
$3,025,470 |
$3,152,420 |
$3,279,515 |
|
Proportion of initial TB suspects tested for NTM, 20% (base-case: 30%) |
- |
- |
- |
- |
- |
|
Total cost of NAAT for TB |
$2,442,440 |
$2,554,500 |
$2,666,430 |
$2,778,490 |
$2,890,420 |
|
Total cost of NAAT for NTM |
$1,127,280 |
$1,179,000 |
$1,230,660 |
$1,282,380 |
$1,334,040 |
|
Total cost of NAAT |
$3,569,720 |
$3,733,500 |
$3,897,090 |
$4,060,870 |
$4,224,460 |
|
Proportion of initial TB suspects tested for NTM, 40% (base-case: 30%) |
- |
- |
- |
- |
- |
|
Total cost of NAAT for TB |
$2,442,440 |
$2,554,500 |
$2,666,430 |
$2,778,490 |
$2,890,420 |
|
Total cost of NAAT for NTM |
$1,315,160 |
$1,375,500 |
$1,435,770 |
$1,496,110 |
$1,556,380 |
|
Total cost of NAAT |
$3,757,600 |
$3,930,000 |
$4,102,200 |
$4,274,600 |
$4,446,800 |
|
Cost of NAAT for NTM, $120 (base-case: $50) |
|
- |
- |
- |
- |
|
Total cost of NAAT for TB |
$2,442,440 |
$2,554,500 |
$2,666,430 |
$2,778,490 |
$2,890,420 |
|
Total cost of NAAT for NTM |
$2,930,928 |
$3,065,400 |
$3,199,716 |
$3,334,188 |
$3,468,504 |
|
Total cost of NAAT |
$5,373,368 |
$5,619,900 |
$5,866,146 |
$6,112,678 |
$6,358,924 |
NAAT = nucleic acid amplification test; NTM = non-tuberculous mycobacteria; TB = tuberculosis
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