Nick Xenophon (SA, Independent) Share this | Link to this | Hansard source

My question is to Senator Ludwig, representing the Minister for Health and Ageing, and it relates to artificial joint replacement. In the Australian newspaper on 25 August this year, the Minister for Health and Ageing is reported to have said:

… 99 per cent of patients are provided joints that are less dependable and often more expensive than the most reliable one …

I ask the minister: is it accurate that in Australia the best prosthesis is used in only one per cent of artificial joint replacements?

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I thank Senator Xenophon for his question on joint replacements. What I can add to that is that the government does need to start a conversation in the community about the sustainable use of health funding and the need to control the growth of health expenditure. It will be a critical part of future health reform, and we do not want to use our scarce health dollars without ensuring that we are using them effectively. We will not be able to improve the health system for the future unless we start to have that conversation.

In terms of joint replacements, the government does not advocate the removal of doctors’ clinical freedom to choose appropriate prostheses for their patients. I think that is critical. It is an important issue for Australians to ensure the quality of the prosthesis that they may be obtaining, and we are confident that doctors, especially orthopaedic surgeons, always use best practice data to improve outcomes for their patients. However, all doctors have a responsibility to use data that is available to guide their clinical choice.

In addition, the National Joint Replacement Registry collects data on all joint replacements undertaken across Australia, and currently 100 per cent of orthopaedic surgeons submit data to the NJRR. The Commonwealth prosthesis list includes about 360 hip and femoral stem components used in primary and revision total hip replacements for which private health insurers must pay benefits. The NJRR report indicated that this stem is used in only about one per cent of hip replacement surgeries.

Nick Xenophon (SA, Independent) Share this | Link to this | Hansard source

Mr President, I ask a supplementary question. The National Joint Replacement Registry was established in 1998 and earlier this year a levy was introduced to support its work. Does this registry record how many of the new joint replacement products approved in the last four years have performed better in relation to rates of revision than the products previously available? If so, how many joints were approved and what proportion performed better?

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

I will add what I can to that, and any part I do not quite cover in this response I will have to take on notice for the Minister for Health and Ageing to add to. Information I have is that the NJRR data indicates that the reliability of prostheses varies and, according to the NJRR 2008 annual report, there is wide-ranging variation in revision rates for hip femoral stems. According to the NJRR’s 2008 annual report, the hip femoral stem with the lowest revision rate has over 1,000 observed component years. However, the NJRR report indicates that this stem is only used in about one per cent of hip replacement surgeries. According to the NJRR report, the next lowest revision rate for a femoral stem is three to four times higher. What the report also tells us is that these femoral stems can cost somewhere in the order of $2,100 on the prostheses list, while others can be up to $7,000. This does not mean that other prostheses— (Time expired)

Nick Xenophon (SA, Independent) Share this | Link to this | Hansard source

Mr President, I ask a further supplementary question. Can the minister inform the Senate how many of these new joint replacements underwent at least two years of clinical trialling prior to being approved for use in Australia?

Joe Ludwig (Queensland, Australian Labor Party, Manager of Government Business in the Senate) Share this | Link to this | Hansard source

In respect of clinical trials of particular prostheses, it is important to look at the data which has been provided by the NJRR. It does not mean that prostheses which are used are wrong or not suitable for particular patients. There may be clinical reasons for using other devices, but it is not clear why the best-performing stem is used so infrequently. What I can add is that about 30 per cent of patients are provided with prostheses which are markedly less dependable than the most reliable ones identified by the NJRR, many of which are more expensive than the most reliable one. In relation to that part of the question about whether or not there have been trials, I will seek the advice of the Minister for Health and Ageing and see if we can provide further particulars.