To the Editor: We were interested to read the article on health services research (HSR) in Australia,1 and the previous editorial and articles on health technology assessment (HTA).2-5

In contrast to Australia’s prominent role in applying HSR and HTA to new pharmaceuticals, there has been very little local development of these techniques in evaluating new diagnostic technologies.

The Quality Use of Diagnostic Imaging program of the Royal Australian and New Zealand College of Radiologists recently examined the introduction of new imaging technologies in Australia, with particular attention to Medicare Benefits Schedule funding. The major findings were:

• Delays of up to 7 years between the emergence of evidence for benefit from a new technology and Medicare listing. A large part of this delay was in the period before application to the Medical Services Advisory Committee (MSAC).

• A lack of significant permanent infrastructure for evidence-based assessment and prioritisation of new imaging technologies. This is in stark contrast to the situation for new pharmaceuticals and surgical procedures.

• Where some published evidence of clinical efficacy exists, but does not meet MSAC requirements, there is no mechanism to trigger targeted trials on questions of safety, efficacy, and cost-effectiveness.

The generation of such evidence is costly, but, arguably, cost-effective in the longer term. Data collection by the Australian and New Zealand Association of Physicians in Nuclear Medicine during the interim funding of positron emission tomography has cost $2.5 million. This “coverage with evidence” approach is used in other countries, like the United States and the United Kingdom, to generate relevant evidence about the performance of emerging technologies when this does not exist in the published literature The current restriction of MSAC reviews to examining existing evidence, rather than sponsoring projects designed to provide specific relevant evidence, ensures continuing delays in the approval of new technologies for Medicare funding.