Dear Mr Murphy

Thank you for your letter of 22 November 2010 concerning a petition regarding bone densitometry testing. In accordance with Standing Order 209 (b) my written response is as follows.

The Australian Government is committed to ensuring that all Australians have access to appropriate and effective medical services.

Currently, Medicare benefits are payable for:

• the diagnosis and monitoring of bone loss if a patient has certain specific medical conditions or is undergoing particular treatments likely to cause rapid bone loss;
• the confirmation of clinically suspected low bone mineral density, usually following a fracture;
• the monitoring of established low bone mineral density; and
• those patients over the age of 70 years.

In order to ensure that items on the Medicare Benefits Schedule (MBS) remain current and reflect best clinical practice, the Department of Health and Ageing, in consultation with the appropriate medical specialists, does review items from time to time as new evidence comes to light.

In 1995, following a review of bone densitometry, public funding was provided for:

• the confirmation of presumptive diagnosis of low bone mineral density;
• the diagnosis and monitoring of bone loss associated with specified conditions; and
• the measurement of bone density 12 months following a significant change in therapy for established low bone mineral density.

It was not supported as a screening service.

In 2007, eligibility of an osteoporosis medication on the Pharmaceutical Benefits Scheme was extended to treat patients over the age of 70 with low bone mineral density without fracture. To coincide with this expanded eligibility for this medication, a new item for testing the bone density of those patients over the age of 70 was added to the MBS.

For Medicare purposes, all bone density testing is subject to a restriction on the time interval between tests, ranging from one every 12 to 24 months, depending on the circumstances. This is because bone density loss is considered a relatively slow process and repeat testing within 24 months is unlikely to assist in clinical decision making. For those specific medical conditions or particular treatments that may cause more rapid bone loss, a rebate is available for repeat testing at 12 monthly intervals.

It is the Government’s aim that services listed in the MBS, including bone densitometry, should reflect and encourage appropriate medical practice based on the best available evidence.

A mechanism currently exists for medical organisations or companies to apply to the Australian Government for listing of and review of tests on the MBS. This is through the Medical Services Advisory Committee (MSAC) which provides advice to the Minister for Health and Ageing on the strength of the evidence relating to the safety, effectiveness and cost-effectiveness of new medical procedures and technologies, and under what circumstances public funding should be supported. The work of the Committee also ensures that Australians have access to safe, effective medical services that represent value for money to them both as patients and taxpayers.

New tests or extension of the indications for existing tests are assessed by expert committees (composed of consumer representatives, health economists, health administrators, clinical experts in pathology, surgery, specialist medicine and general practice as well as health technology assessment professionals), and Medicare rebates are provided for those tests that are proven to be safe, effective, and cost-effective.

Should more evidence become available an application can be made to MSAC to review the current bone densitometry items and the options for extending them to include other clinical indicators and age groups. Information on the application process and the contact details for MSAC can be obtained on the website at www.msac.gov.au

As you may be aware, Australia does not currently have a population based screening program for osteoporosis. In determining whether there is sufficient evidence to establish an organised screening program, the Australian Government has developed a Population Based Screening Framework. A copy of the Framework is available at www.cancerscreening.gov.au

The Screening Subcommittee of the Australian Population Health Development Principal Committee provides guidance to decision makers when assessing potential screening programs in Australia.

At its 6 July 2010 meeting, the Screening Subcommittee considered a proposal for the prevention of osteoporosis in women. The Screening Subcommittee agreed that the proposal has merit, however, it identified some significant gaps when considering the proposal against the specific criteria of the Population Based Screening Framework.

Consequently, the Screening Subcommittee determined that the proposal did not meet the requirements for a population based screening program.

Thank you for taking the time to raise your concerns. I trust that the above information is of assistance.

from the Minister for Health and Ageing, Ms Roxon