Medicare funding has been recommended for a non-invasive ultrasound alternative to deep brain stimulation to control the symptoms of refractory essential tremor.
The Medicare Services Advisory Committee (link) has supported a submission from Insightec requesting MBS items for reimbursement of magnetic resonance guided focused ultrasound (MRgFUS) for the treatment of medically refractory essential tremor.
The committee noted that MRgFUS is a non-invasive one-step method that combines MRI and ultrasound pulses to heat and only destroy a specific area of brain tissue that is the source of tremor (ie the ventralis intermediate nucleus of the thalamus).
MSAC said that despite limitations of existing clinical evidence it recognised that MRgFUS was at least as effective as deep brain stimulation surgery and addressed an unmet clinical need for patients with disabling tremor, providing them with the choice of a procedure that was more effective than best supportive care, but less invasive than deep brain stimulation surgery, and with a different pattern of safety concerns.
It noted consumer feedback highlighting the detrimental effects of having suffered tremors for many years, and that after receiving MRgFUS a patient could return to work, have much improved self care and enjoying social interaction again. One patient labelled MRgFUS “a medical miracle”. Other benefits included a short recovery time, no overnight stay in hospital, and reduced medication and associated costs.
However in it decision summary, the committee said that listing on the MBS would depend on a suitable set of item descriptors and fees being agreed upon.
“MSAC considered the fees for the separate items for treatment by the neurosurgeon and neurologist to be very high and not adequately justified. MSAC considered the fees should depend on the length of the procedure … and should be calculated according to a comparative time-based structure,” it said.
The committee also raised concerns that there may be high out of pocket costs to consumers as it was unclear whether the cost of certain device consumables used with the procedure could be covered by the Prostheses List.
The intervention is currently available as a self-funded treatment in two private centres in Australia (St Vincent’s Hospital, Sydney, and the Future Medical Imaging Group Centre, Melbourne) and there would be significant equity of access issues if the treatment was funded on Medicare, the committee cautioned.