Ophthalmologists hopeful of positive outcome for MIGS

The device was previously covered under MBS it 42758 (goniotomy), but a limitation implented by the government on May 1 meant MIGS could no longer be billed for MBS rebates using that it number.Prior to the government restriction, it 42758 was generally only used for children with congenital glaucoma, restricting its implantation to about 20 procedures per year. However, technology advances had led to a substantial increase in its use and subsequent billing through Medicare, which in turn led to a review and the proposed creation of its own specific MBS number.{{quote-a:r-w:400-I:2-Q:“The advantage from the government’s perspective is that if its in combination with cataracts, then the rule applies where the Medicare rebate is only 50% of the second procedure, resulting in a cost-saving.”-WHO:Geoff Pollard, CEO Glaucoma Australia}}Lobbying from RANZCO helped establish a tporary MBS number for the review period, but it is only applicable for patients who also require cataract surgery – a decision criticised by the College, the Australian Society of Ophthalmologists (ASO) and Glaucoma Australia (GA).The Department of Health has since justified this position: “Between February 2014 and May 2017, MBS it 42758 was co-claimed with MBS it 42702 for cataract surgery on 91% of occasions. This interim it would therefore accommodate most patients who require this service,” a spokesperson told Insight.However, outgoing GA CEO Mr Geoff Pollard said that figure may not necessarily paint an accurate picture and could be more related to cost savings than clinical considerations.“Undertaking both procedures together can make it less costly but it’s still expensive as there are other fees to pay outside of the procedure itself,” he explained.“The advantage from the government’s perspective is that if its in combination with cataracts, then the rule applies where the Medicare rebate is only 50% of the second procedure, resulting in a cost-saving to government. In any case, if few people are undertaking MIGS as a standalone procedure, what would be the issue in funding it with a Medicare it if it wasn’t going to be used much?”So far, GA has had no indication from government whether or not a permanent MBS number for MIGS would encompass standalone procedures, but Pollard said the priority to should be to provide the best possible care for patients.“The need is still there, particularly for older Australians – one in eight 80-year-olds have glaucoma for example – who may need these procedures later in life, when they have likely already had their cataracts done. There will also be a group of people, regardless of age, who will not be suitable for medication because of adverse event profiles and other concurrent diseases, or allergies, who just need an option between first line treatment, such as medications and laser trabeculoplasty, and incisional surgery.“It’s a big leap between taking medication, to having a trabeculectomy done on you or a tube or a plate put in. It’s like using a hammer to crack a walnut.”One of the two applications for permanent MBS numbers was made on behalf of ophthalmic medical technology company Glaukos, which pioneered MIGS devices and helped advocate their mainstream use. It was also a driving force behind lobbying the government to fast track a new permanent MBS number and submitted a detailed application that will be used in part to help review the safety, cost effectiveness and efficacy of the technology.{{quote-a:r-w:400-I:3-Q:“A new MBS it number will be welcomed by Australian patients and the ophthalmic community in Australia.”-WHO:Thomas Burns, Glaukos CEO and President}}CEO and president Mr Thomas Burns acknowledged the Health Minister and DoH for allowing patients to access the technology during the review process via the tporary MBS number, and said the company was looking forward to a final decision.“Our submission was lodged in April of this year with a request for expedited review and a final recommendation to the Minister of Health before year end.  The TGA approval of iStent inject for use in connection with and without cataract surgery, is reflected in our application to allow access for both patient groups,” he said.“A new MBS it number will be welcomed by Australian patients and the ophthalmic community in Australia.”RANZCO was also asked to communicate its position on MIGS to MSAC and CEO Dr David Andrews said the College was awaiting the outcome of the review with interest.“To provide feedback to the MSAC Committee, we sought advice from the Australia and New Zealand Glaucoma Society (ANZGS), which is one of RANZCO’s special interest groups. ANZGS supported the use of MIGS where appropriate and, although it is a new device and the body of evidence is continuing to build, they confirmed that there is a place for MIGS in treating certain types of glaucoma,” he said.However, while MSAC has reviewed all of the information presented to it by the various stakeholders involved, ultimately, the decision will rest with the Federal Health Minister, Mr Greg Hunt. Hunt was contacted for comment by Insight, but he declined, because at that time the MSAC process had not yet been completed.