1. Welcome to the second issue of the HealthPACT Bulletin for 2011.
Since the June issue of the Bulletin, HealthPACT has been involved in
some exciting activities, while undertaking more proactive scanning of new
technologies.
At the August HealthPACT meeting, a number of jurisdictions presented
their experience with mapping of technologies employed in various clinical
streams. Similarities and differences in the maps were evident, influenced by
clinical preferences, predicted clinical demand, and current exposure to
various technologies. There is potential to coordinate technology mapping
nationally to reduce the potential for duplicated effort, and to offer more
rapid progress through those disorders with the greatest burden of disease
and potential for benefit from the technologies. It was agreed to focus on
new and emerging technologies by disease category, looking at burden of
disease, volume, and cost.
In November, HealthPACT facilitated a workshop on intestinal
transplantation, in collaboration with the Nationally Funded Centres
Reference Group (NFCRG). The workshop examined the provision of
intestinal transplantation services within the Australian and New Zealand
health care systems, with participants describing an optimal system where
the service system would be defined as a continuum for the management of
intestinal failure. The next steps following this workshop will be considered
by NFCRG and HealthPACT.
Health Policy Advisory Committee on Technology Bulletin Issue 18 – December 2011
Issue 18, December 2011
HealthPACT Bulletin
Health Policy Advisory Committee on Technology
Australia and New Zealand
New and Emerging Technology
In This Issue...
Technologies for the inactivation of
pathogens in blood products 2
Peptide receptor radionuclide therapy
for the treatment of neuroendocrine
tumours 4
Extracorporeal photopheresis
for the treatment of graft-versus-host
disease 5
Total artificial heart 6
Faecal microbiota transplantation 7
Intestinal transplant workshop 8
Selective internal radiation therapy
for the treatment of liver cancer 9
MRI-guided, high-intensity focussed
ultrasound for the treatment of
cancer 10
High sensitivity troponin assays for the
diagnosis of myocardial infarction 12
News round-up 13
HTAi 2012 14
From the Chair
HealthPACT continues to prepare or commission a range of
new and emerging technology reports and technology briefs,
some of which you will find summarised in this issue.
On behalf of HealthPACT, I would like to wish our
colleagues in the health technology industry a safe and happy
Christmas, and all the best for 2012.
Best Regards, Brendon Kearney
Chair of HealthPACT

2. Technologies for the inactivation or reduction of
pathogens in blood products: Executive Summary
This New and Emerging Health Technology Report was
commissioned by HealthPACT on behalf of CTEPC and the
Jurisdictional Blood Committee.
Existing pathogen reduction/inactivation strategies employed
by the Australian Red Cross Blood Service (ARCBS) include
epidemiological control of donors and leucocyte depletion,
complemented by routine serological and nucleic acid testing
(NAT) of the end product. Serologically and NAT negative
plasma is forwarded on to CSL Biotherapies for use in the
manufacture of plasma derived products.
The 2 main pathogen reduction technologies (PRT) identified
for inclusion in this report were: the INTERCEPT Blood
System™ and the Mirasol® Pathogen Reduction Technology,
both of which are designed for use at the blood collection
centre level. Neither system is listed on the Australian Register
of Therapeutic Goods, nor approved by the FDA, however
both products are CE marked for use in the European Union.
Both systems use agents which form cross-links between the
base pairs of nucleic acids, halting transcription (see figure
below). Both systems inactivate a range of pathogens (viruses,
bacteria and parasites) in the non-nucleated components of
blood: plasma, platelets and potentially red blood cells, how-
ever both systems are ineffective against infectious prions.
The INTERCEPT Blood System™ uses the psoralen,
amotosalen, which is activated after exposure to ultraviolet-A
light. The Mirasol® system uses riboflavin, or vitamin B2, as
its photosensitising agent, which binds to pathogen nucleic
acids and is oxidised after exposure to ultraviolet-B or visible
light.
The advantages of these PRT systems include:
 the potential to eliminate the threat from as yet
unknown pathogens;
 the inactivation of residual white blood cells, ne-
gating the need to gamma irradiate plasma or
platelet products for the prevention of graft-
versus-host disease (GVHD);
 the elimination of the risk of transfusion transmit-
ted infection during the so-called “window pe-
riod”, when viral and antibody levels are too low
for detection in infected blood obtained from
asymptomatic donors; and
 increased shelf life of platelets from 5 to 7 days,
which may lead to a significant reduction in wast-
age due to expired product.
The disadvantages of these PRT systems include:
 a reduction in product volume (a 10-15% loss of
platelet yield during treatment);
 the INTERCEPT™ system is reported to be in-
effective at inactivating hepatitis A, a non-
enveloped virus; and
 both systems are ineffective against infectious
prions.
Above: The mechanism for the use of psoralens to destroy pathogen DNA or RNA
Bryant, B. J. & Klein, H. G. (2007). 'Pathogen inactivation: the definitive safeguard for the blood supply', Arch Pathol Lab Med, 131 (5), 719-733.
HealthPACT Bulletin
2. Issue 18 – December 2011

3. Mirasol®
Pathogen Reduction Technology System
Only one randomised controlled trial describing the use of the
Mirasol® system was included in this report. Adverse events
among thrombocytopenia patients transfused with Mirasol®-
treated or standard platelets were reported. The frequency of
all adverse events, including serious adverse events and death
were similar for both groups, and while almost all patients
experienced an adverse event of some sort, few of these were
attributable to platelet transfusions. Of all the adverse events
reported, including death, none could be attributed to the use
of the Mirasol® system, but were rather a reflection of under-
lying morbidity among both groups of thrombocytopenic
patients.
On the basis of the between group difference in mean
corrected count increments (CCI) at one hour following
platelet transfusion, Mirasol®-treated platelets were found to
be inferior to standard platelets (p<0.0001). However, an
examination of patient bleeding episodes did not show any
significant differences between the treatment groups. The
odds of achieving a successful platelet transfusion as measured
at one hour post-transfusion were lower for patients who re-
ceived Mirasol®-treated platelets than for patients transfused
with standard platelets (OR=0.28; 95% CI [0.11, 0.77];
p=0.013).
Intercept Blood System/amotosalen
Three RCTs indicated similar safety profiles for throbocyto-
paenic patients transfused with INTERCEPT™/amotosalen-
treated platelets and those who received standard platelets. In
an RCT of 645 patients, adverse events were experienced by
almost all patients regardless of whether they received
amotosalen or standard-treated platelets, but less than a third
of patients in either arm had treatment related adverse events.
No significant differences in safety outcomes were observed
and most of the 28 reported deaths were due to infectious or
respiratory complications. A RCT of 242 patients reported
adverse events among a third of patients in both the
amotosalen and standard platelets study arms, with 9.5 and
6.6% of these events attributed to platelet transfusion (p=NS),
respectively. The 6 deaths that occurred were considered to be
related to underlying disease in all but one patient from the
amotosalen arm, who experienced a severe immune reaction
with haemorrhaging. An additional analysis of the safety data
from this RCT indicated that amotosalen-treated platelets may
be associated with substantially higher incidences of acute
respiratory distress syndrome (ARDS). Given ARDS is associ-
ated with a 40% mortality rate, the potential gains in terms of
infections averted due to PRT with amotosalen may be out-
weighed by an increase in clinically serious pulmonary
complications. In contrast, the evidence included in this
assessment primarily indicates that amotosalen-treated
platelets are not inferior to standard platelets in clinical
effectiveness. One RCT did report conflicting results which
prompted the US Food and Drug Administration to recom-
mend duration of bleeding as a preferable measure of haemo-
static efficacy over the proportion of patients experiencing
bleeding.
Two additional pathogen reduction agents were identified:
S303 and methylene blue. S303 had a favourable effectiveness
and safety profile based on the assessed evidence, while the
lack of comparative evidence for methylene blue makes the
effectiveness of this method uncertain, although it does
appear to be safe.
Several cost-effectiveness studies were included in this report,
the most recent was conducted in Canada, and as such may be
generalisable to the Australian health system. This study re-
ported on the use of the Mirasol® system as an addition to cur-
rent pathogen reduction measures rather than as a replacement
technology to reduce TTIs against known pathogens and non-
infectious threats, including GVHD. The overall incremental
cost-effectiveness ratio in Canadian dollars was $1.3 million
and $1.4 million per QALY when used for whole blood and
platelets and plasma, respectively. PRT became more cost-
effective when the risk of infection increased.
The choice of whether to adopt universal PRT will depend on
a risk assessment which characterises the potential for
exposure to known and unknown blood-borne pathogens and
determine whether further diminishment of risk is worth the
additional costs of PRT. It is recommended that a cost-
effectiveness analysis in the context of the Australian health
system be conducted assessing the use of PRT as both an
additive and replacement risk reduction measure.
Written by Ben Ellery and Linda Mundy, AHTA
For a full copy of the report please contact the HealthPACT
Secretariat
Issue 18 – December 2011 3.
HealthPACT Bulletin

4. Peptide receptor radionuclide therapy for the
treatment of neuroendocrine tumours:
Executive Summary
Neuroendocrine tumours comprise a heterogeneous group of
cancers that often remain asymptomatic until the primary
tumour has metastasised. Once the cancer has spread
treatment becomes difficult with complete surgical resection
unlikely. Several treatment options exist to treat advanced
neuroendocrine tumours including surgery, somatostatin
analogues, chemotherapy, growth factor inhibitors and liver-
directed therapies. The choice of therapy employed is deter-
mined by the stage of disease, and the size and aggressiveness
of the tumour(s).
Peptide receptor radionuclide therapy (PRRT) has been
trialled for almost 20 years as an alternative treatment for
advanced progressive neuroendocrine tumours. A
somatostatin analogue is labelled with a high-energy radioiso-
tope, usually Yttrium-90 (90Y) or Lutetium-177 (177Lu), and
administered to the patient intravenously. These peptides
target and bind to somatostatin-receptors most commonly
expressed on neuroendocrine tumour cells, resulting in a
highly specific systemic treatment option for advanced neuro-
endocrine tumours.
Available evidence suggests that PRRT is highly effective in
controlling advanced progressive neuroendocrine tumours.
Although complete response rates are relatively low, the
percentage of patients with partial remission and stable disease
following treatment is high. Haematological and/or renal
toxicity is relatively low.
4. Issue 18 – December 2011
To date, clinical trials designed to assess the safety and
efficacy of PRRT have limitations that diminish the utility
of data
produced. Firstly, the nature of the tumours treated (i.e.
the size, location and extent of liver involvement) varies
significantly, both within and between studies, making it
difficult to determine which patient populations respond
best to treatment. Secondly, there are no studies that assess
the safety and efficacy of PRRT in patients with newly
diagnosed neuroendocrine tumours, as the vast majority of
included
patients have presented with advanced disease after having
unsuccessfully undergone alternative treatment options.
Thirdly, there are no randomised controlled trials or other
comparative studies through which to objectively assess
the benefit of PRRT compared with other modes of treat-
ment.
Many avenues can be explored with the aim of improving the
safety and efficacy of PRRT. These include the development
of new somatostatin analogues with higher receptor affinities,
improved drug delivery, the establishment of more accurate
dosimetry profiles and by combining radionuclide therapy
with other modes of treatment. Unfortunately, due to the
relatively low number of patients with neuroendocrine tu-
mours, a lack of financial investment by pharmaceutical
companies may delay the time needed for PRRT to reach its
full potential.
Written by Heath White and Deanne Forel, ASERNIP-S
For a full copy of this report please contact the HealthPACT
HealthPACT Bulletin
 NEWS FLASH
Billion-dollar saving beckons from IV drip research
The NHMRC is providing $1.56 million funding for a study that aims to
examine the use of IV drips in intensive care units and hospital wards. Cur-
rent clinical practice dictates that IV tubing is changed every three to four
days which that costs Australia about $1 billion annually. This practice is
not based on evidence and early trials have demonstrated the safety of pro-
longed use of IV tubing. The RSVP study, conducted by Professor Claire
Rickard from the Griffith Health Institute, will involve 6,500 patients
across five Queensland hospitals, and will compare infection rates and
costs of IV tubing changes on four and seven days.

5. ECP for the treatment of GVHD
Graft-versus-host-disease (GVHD) is a major cause of mor-
bidity and mortality following allogeneic stem cell transplants.
Its pathogenesis is poorly understood, however it is essentially
caused by T lymphocytes from the donor graft recognising the
tissue of the transplant recipient as foreign and mounting an
immune response.1 Symptoms of GVHD resemble those of
autoimmune disorders, affecting the skin, liver, GI tract, lungs
and lymphoid tissue.2 The incidence of acute GVHD ranges
from 20-80% depending on the stem cell source. Mortality
may be as high as 50% in patients with moderate to severe
acute GVHD. The incidence of chronic GVHD ranges from
30 to 70% depending on donor source.2,3
HOW IT WORKS
Extracorporeal photopheresis (ECP), using the Therakos™
system, involves drawing whole blood from the patient. The
red blood cells are separated from the white cells (WBCs) and
returned to the patient. 8-methoxy-psoralen (8-MOP), is
added to the purified WBCs where it cross-links the strands of
DNA. After mixing, the treated WBCs are circulated through
a photo-activation chamber between 2 banks of UVA light.
After UVA treatment, the WBCs are returned to the patient.4
Initial therapy may consist of 3 treatments per week for 2-3
months, with follow-up weekly treatments for up to 12-
months. The mechanism of ECP action aims to strengthen
the response of the suppressor cells responsible for
recognition of self, or tolerance, “tipping” the immune
response away from an active response towards tolerance.4,5
THE EVIDENCE
A retrospective case series reported on the clinical and survival
outcomes of 27 paediatric patients who developed GVHD (6
acute and 21 chronic GVHD) and were treated with ECP fol-
lowing treatment failure with standard steroid regimes. 48% of
patients underwent allogeneic haematopoietic stem cell
transplantation for acute lymphoblastic leukaemia. Donors
were HLA matched in 17 cases and 14 donors were related to
the recipient.6
A total of 225 ECP procedures were performed (median 6 per
patient) with a median time spent on ECP of 30 days (range 2-
442 days). Of the 21 aGVHD patients, 11 reached complete
remission (responders) and 8 reached partial remission. Of the
cGVHD patients, 3 (50%) achieved complete remission, with
2 in partial remission. One cGVHD and two aGVHD patients
were considered non-responders. Median time to response
was two and four cycles in aGVHD and cGVHD patients.
Adverse events related to the procedure were observed in 5
patients: 3 developed mild hypotension and 3 had a catheter–
related infection, all of which were resolved. During follow-up
16 patients died. As a whole group, the probability of disease-
free survival was 43 ± 9%. In a multivariate analysis only com-
plete remission had an effect on disease-free survival
(p<0.0001). The probability of disease-free survival was sig-
nificantly higher in responders who experienced complete
remission (69 ±12%, n=14) compared to non-responders (16
±10%, n=13, p=0.02). Results of the all of the studies in-
cluded for assessment may be viewed in the full brief available
from the HealthPACT Secretariat.
Written by Linda Mundy, HealthPACT Secretariat
Issue 18 – December 2011 5.
REFERENCES
1. Salmasian, H., Rohanizadegan, M. et al (2010). 'Corticosteroid regimens for treatment of acute and chronic graft versus host disease (GvHD) after allogenic stem cell transplanta-
tion', Cochrane Database Syst Rev, (1), CD005565.
2. Penas, P. F. & Zaman, S. (2010). 'Many faces of graft-versus-host disease', Australas J Dermatol, 51 (1), 1-10; quiz 11.
3. Foss, F. M. (2003). 'Extracorporeal photopheresis in the treatment of graft-vs-host disease', J Cutan Med Surg, 7 (4 Suppl), 13-17.
4. Ward, D. M. (2011). 'Extracorporeal photopheresis: How, when, and why', J Clin Apher.
5. Chiesa-Fuxench, Z. C. & Gonzalez-Chavez, J. 'Extracorporeal photopheresis: a review on the immunological aspects and clinical applications', P R Health Sci J, 29 (4), 337-347.
6. Gonzalez Vicent, M., Ramirez, M. et al (2010). 'Analysis of clinical outcome and survival in pediatric patients undergoing extracorporeal photopheresis for the treatment of ster-
oid-refractory GVHD', J Pediatr Hematol Oncol, 32 (8), 589-593
7. Matthews, L. (2011). Lyme Arthritis Treatment – Photochemotherapy [Internet]. Lyme Disease Guide.org. Available from: http://lymediseaseguide.org/lyme-arthritis-treatment-
photochemotherapy [Accessed 21st September].
HealthPACT Bulletin
Below: Extracorporeal photopheresis (printed with permission7).

6. End-stage refractory biventricular heart failure is the most life-
threatening manifestation of the heart-failure syndrome. Treat-
ment options available to patients with this condition include
palliation, placement of a biventricular assist device (BiVAD),
or orthotopic heart transplantation. Heart transplantation is
only available to a small percentage of eligible patients due to a
shortage of donor hearts, while the reported survival rate with
BiVADs has been shown to be between 40 and 50%.
HOW IT WORKS
The total artificial heart (TAH) has been developed for use as a
bridge-to-transplant, with the aim of increasing the survival rate
of cardiac transplant-eligible patients. This device is capable of
completely restoring systemic and pulmonary blood circulation
and organ perfusion in patients who are at risk of imminent
death, due to end-stage refractory biventricular heart failure.
There are 2 commercially available TAH devices: the SynCardia
TAH (SynCardia Systems Inc, Tucson, Arizona) and the AbioCor
TAH (Abiomed Inc, Danvers, Massachusetts).
The SynCardia TAH, which completely replaces a patient’s native
ventricles and all 4 cardiac valves, is a biventricular pneumatic
pulsatile pump consisting of 3 components: prosthetic ventricles,
drivelines, and an external pneumatic driver. The SynCardia TAH
is intended for in-hospital use mainly due to the need to be
attached to a large power supply. However, recently a portable
power source has been developed which allows patients to be
discharged home once their condition has stabilised. Discharge
home has been further eased with the replacement of the initial
mobile driver with the lighter SynCardia Freedom portable driver
which can be carried in a shoulder bag or worn in a backpack.
Initial use of this driver has been positive, and patients have re-
ported feeling well, and being self-ambulatory, with a significant
return to normal function while at home.1
THE EVIDENCE
One study assessed the co morbidity and survival of patients
awaiting heart transplants while receiving circulatory support
with the SynCardia TAH. 2 This study reported that optimal
haemodynamic function was restored following TAH
implantation. The main cause of death was multiple organ
failure; however, no device dysfunction-related deaths were
reported. A rate of survival to transplantation of 71.5% was
reported, while long-term survival after transplantation was
76% at 10 years.
Another study demonstrated that aerobic exercise training, as
part of a physical rehabilitation program early after TAH
implantation, is safe and feasible in a supervised setting;
however, when compared with patients on LVADs, TAH
patients have a blunted BP response to exercise.3 The results
of this study are particularly relevant, with the rehabilitation
and mobility of patients following TAH implantation
becoming increasingly important, as the portable SynCardia
Freedom portable drive is introduced and more patients are
able to return home after device implantation
FUTURE STEPS
Given the significant costs associated with this technology, it
is suggested that it be targeted at eligible younger patients who
have developed heart failure prematurely. There are currently
2 clinical trials in progress assessing this technology, one of
which is an FDA approved IDE trial of the SynCardia
Freedom portable driver. Therefore, HealthPACT have
recommended that this technology be monitored for 12-
months, as the results of this ongoing trial may determine
whether patients can function adequately with the TAH and
Freedom portable driver outside of the hospital setting
Written by Dr Prema Thavaneswaran from ASERNIP-S
REFERENCES
1. Slepian MJ. The SynCardia temporary total artificial heart – evolving clini-
cal role and future status. US Cardiology 2011; 8: 39-46.
2. Roussel JC, Sénage T, Baron O, Périgaud C, Habash O, Rigal JC, Treilhaud
M, Trochu JN, Despins P, Duveau D. CardioWest (Jarvik) total artificial
heart: a single center experience with 42 patients. Annals of Thoracic Surgery
2009; 87:124-129.
3. Kohli, H.S., Canada, J. et al (2011).. Exercise blood pressure response
during assisted circulatory support: Comparison of the total artificial heart
with a left ventricular assist device during rehabilitation. Journal of Heart and
Lung Transplantation; 30: 1207-1213
HealthPACT Bulletin
Total artificial heart for end-stage refractory
biventricular heart failure
The SynCardia implantation procedure: the 4 native heart valves are removed,
the TAH is implanted and attached via 4 quick connects. When a donor heart
becomes available, the SynCardia TAH and quick connects are removed and the
donor heart is transplanted (printed with permission SynCardia Inc).
6. Issue 18 – December 2011

7. Clostridium difficile is the most common cause of infectious hos-
pital-acquired diarrhoea in developed countries, resulting in
significant patient morbidity and mortality in addition to in-
creasing health-care costs. Rates of C. difficile infection have
been increasing, in particular, a highly virulent, novel strain,
referred to as B1/NAP1/027. Infection is associated with:
antibiotic use, which disrupts the normal flora of the colon;
gastric acid suppressive therapy; old age; nasogastric feeding;
immunosuppressive therapy; prolonged hospitalisation or
residence in a long-term care facility.1,2
HOW IT WORKS
Faecal bacteriotherapy or transplantation has been proposed
as a means of reconstituting the diversity of the normal flora
of the colon. On the morning of the procedure, a stool sample
is collected from a healthy donor who has been screened for
any potential infectious disease, and for the presence of C.
difficile toxin. Donors from the same domestic household, ide-
ally a spouse or partner, have been preferred as it has been
suggested that pathogens and flora are likely to have been
shared by both participants. The collected stool sample is liq-
uefied sufficiently into a suspension using non-bacteriostatic
saline to allow passage through a syringe, whilst minimising
the volume and maximising the bacterial concentration. The
suspension is filtered to remove any large particulate matter.3,4
The donor stool suspension is instilled into the upper gastro-
intestinal tract via a naso-duodenal catheter, or into the colon
through a colonoscope or a retention enema catheter.
THE EVIDENCE
The largest study included for assessment was a retrospective
case series (n=40) that reported on the use of faecal transplan-
tation in patients who had been hospitalised due to recurrent
C. difficile-associated disease (CDAD).5 CDAD had developed
in all patients (mean age 75 years) following antibiotic treat-
ment for other infections. Patients were treated with antibiot-
ics until symptoms of CDAD were reduced. Antibiotic ther-
apy ceased the evening prior to transplantation. Donor stool
samples were obtained from close relatives or household
members. Two patients underwent colonic instillation of do-
nor stool, and of these, one required a second instillation. The
remaining 38 patients underwent duodenal instillation, and of
these, 4 required a second instillation. Successful treatment
was defined as no clinical symptoms of CDAD 80-days post-
transplantation. Faecal transplantation was considered a
success in 29 (73%) patients after the first instillation, 28 of
who underwent duodenal and one colonic instillation. Of the
11 patients who did not respond to the initial transplantation,
6 underwent a second instillation, which was successful in 4
cases: 3 duodenal and one colonic instillation. Overall 33
patients (82.5%) responded to transplantation. Of the 7 who
failed to respond, 2 responded to treatment with
corticosteroids. The remaining 5 patients had serious
co-morbidities and died from causes not related to the treat-
ment. No adverse events associated with the procedure were
reported.
Results of the all of the studies included for assessment may
be viewed in the full brief available from the HealthPACT
Secretariat.
FUTURE STEPS
There is considerable uncertainty surrounding the efficacy of
the faecal transplantation procedure as a treatment option for
refractory C. difficile infection. It would be prudent to await the
publication of results from the randomised controlled trial
conducted in the Netherlands; therefore HealthPACT have
recommended that information on this technology be noted
and that no further research by HealthPACT is warranted at
this time.
Written by Linda Mundy, HealthPACT Secretariat
REFERENCES
1. McGregor, A., Riley, T. & Van Gessel, H. (2008). 'Clostridium difficile associ-
ated disease', In: Cruickshank, M. and Ferguson, J. (eds), 'Reducing harm to
patients from health care associated infection: the role of surveillance', Aus-
tralian Commission on Safety and Quality in Health Care, Sydney, NSW.
2. Stuart, R. L. & Marshall, C. (2011). 'Clostridium difficile infection: a new
threat on our doorstep', Med J Aust, 194 (7), 331-332.
3. Bakken, J. S. (2009). 'Fecal bacteriotherapy for recurrent Clostridium difficile
infection', Anaerobe, 15 (6), 285-289.
4. Rohlke, F., Surawicz, C. M. & Stollman, N. (2010). 'Fecal flora reconstitution
for recurrent Clostridium difficile infection: results and methodology', J Clin
Gastroenterol, 44 (8), 567-570.
5. Garborg, K., Waagsbo, B. et al (2010). 'Results of faecal donor instillation
therapy for recurrent Clostridium difficile-associated diarrhoea', Scand J Infect
Dis, 42 (11-12), 857-861.
HealthPACT Bulletin
Faecal microbiota transplantation
Below: High magnification micrograph of C. difficile
Issue 18 – December 2011 7.

8. HealthPACT Bulletin
Intestinal Transplantation Workshop 10 November 2011
ence of providers varies. There is no formalised service sys-
tem configuration in any jurisdiction. In addition, there was
discussion without consensus about whether (or how)
paediatric and adult intestinal failure services should be linked,
recognising that services for children should be provided in
paediatric settings.
The suggestion that some patients could be considered for
overall referral while the local service is gaining volume and
experience was not supported by participants. It was strongly
proposed that a local service should be supported and
resourced to provide high quality services and overseas
referral of any patients would be inappropriate.
Participants agreed that the following should be undertaken:
 Development of an economic model to clarify the
economic impact of various approaches and to determine
whether intestinal transplantation is a cost-effective
approach in suitable patients.
 Clear definition of the preferred service system
configuration, model of care and referral pathways with
encouragement to jurisdictions to implement them and
fund them appropriately.
The Workshop Report will be available on the HealthPACT website
early in 2012.
The Government announced on 8th December 2011that they
will introduce a comprehensive package of reforms for
Australia’s Therapeutic Goods Administration (TGA) to
ensure the regulation of medicines and medical devices is
more effective and transparent. Releasing TGA reforms: A blue-
print for TGA’s future, the Parliamentary Secretary for Health
and Ageing, Catherine King, said that several important re-
views of the TGA regulatory system have highlighted a num-
ber of issues of concern to consumers, health professionals
and the regulated industry. “In recent times, the TGA has
been hampered by concerns around transparency and an in-
ability to tackle some of the core issues that concern
consumers” Ms King said. “These include the effectiveness of
complementary medicines, their promotion and the adequate
evaluation of some high risk medical devices” Ms King said.
“The reforms will enhance the regulatory framework, ensuring
that it remains adaptable to community and industry
expectations”.
NEWS FLASH
“They will also improve the Australian community’s under-
standing of the TGA’s regulatory processes and decisions and
enhance public trust in the safety and quality of therapeutic
goods.” Ms King said over the past 18 months the govern-
ment has received more than170 public submissions across
seven separate reviews into the operations of the TGA. The
reforms would be implemented in stages, with the TGA work-
ing closely with consumers, health professionals and industry
to ensure the new regulatory arrangements are appropriate,
efficient and fully transparent.
8. Issue 18 – December 2011
On 10 November 2011, HealthPACT facilitated a workshop
which brought together clinicians, health service managers
and policymakers to examine the provision of intestinal
transplantation services within the Australian and New Zea-
land health care systems.
The impetus for the workshop was a previous
unsuccessful submission for intestinal transplantation ser-
vices to be included in the Nationally Funded Centres (NFC)
program. The NFC Reference Group had concluded that the
service system for intestinal failure is underdeveloped in Aus-
tralia and that further work may be required to develop an
evidence-based patient pathway from diagnosis, initial
management and intestinal rehabilitation through to
transplantation. The workshop explored issues relevant to
the current service system for intestinal failure and com-
menced defining the scope of any future work.
The first Australian transplant was performed successfully at
the Austin Hospital in July 2010. Professor Julie Bines, Chair
of Paediatrics, Royal Children’s Hospital and Dr Adam
Testro, Gastroenterologist and Liver Transplant Physician,
Austin Health, presented the Austin and Royal Children’s
Hospital experience.
It was agreed that the adult service system is more
distributed than the paediatric service system and the experi-

9. The incidence of liver cancer has steadily increased in recent
years with the most common form of primary liver cancer in
adults being hepatocellular carcinoma. Surgical resection is the
best curative option for liver cancer with chemotherapy play-
ing an important role in the treatment of liver metastases.
Selective internal radiation therapy (SIRT) is a new modality
for the treatment of primary and metastatic liver cancer. It is
used in the treatment of patients with non‑resectable
hepatocellular carcinoma or liver metastases.
HOW IT WORKS
Radioactive microspheres containing the beta radiation
emitting isotope yttrium-90 are delivered to the tumorous part
of the liver via injection into the hepatic artery.
SIRT involves the delivery of high-energy beta particles or
spheres loaded with yttrium-90 (with a half-life of 64 hours
and maximum tissue penetration of 11 mm) that are delivered
to the tumourous part of the liver via the hepatic artery,
through either a surgically implanted permanent hepatic artery
port or a percutaneous transfemoral hepatic artery catheter.
The increased yttrium concentration within the microvascula-
ture of the liver tumour produces a local radio-therapeutic
effect. SIRT, also known as radio-embolisation or transarterial
radio-embolisation (TARE), is a new and developing modality
for managing liver cancers that are not amenable to surgery.
Two products have been identified for use in SIRT (at the
time of writing): SIR-Spheres® (Sirtex Medical Limited,
Australia) and TheraSphere® (Nordion, Canada).
THE EVIDENCE
Results from the three randomised controlled trials included in
this assessment are summarised below:1-3
 Safety issues relating to grade 3 and 4 toxicity
(against standard treatments);
 SIRT patients demonstrated higher tumour response rates
than patients who received comparator treatments (none
statistically significant);
 SIRT patients showed better outcomes in terms of hepatic
progression;
 Progression-free survival and overall survival were better in
SIRT patients (none statistically significant);
 Two reported QOL outcomes not significantly different
between treatment groups;
 Indications that there is a likelihood of achieving better
tumour response, and time to progression or progression-
free survival using SIRT; and
 Effectiveness outcomes measured included tumour
response rate, time to disease progression in the liver,
survival rate and QOL. All results significantly favoured
using SIRT for treatment of liver metastases.
This technology is currently at a stage of near development in
Australia.
FUTURE STEPS
The available evidence appears promising and highlights the
potential benefits of SIRT for the treatment of liver cancer;
however, a company-based trial is currently underway, the
results of which are scheduled to be presented to Medical
Services Advisory Committee in due course. As such, Health-
PACT have recommended that no further assessment of SIRT
is required at this time. For a full copy of this brief please con-
tact the HealthPACT Secretariat.
Written by Dr Yasoba Atukorale from ASERNIP-S
HealthPACT Bulletin
REFERENCES
1. Hendlisz A, Van den Eynde M, et al. Phase III trial comparing protracted
intravenous fluorouracil infusion alone or with Yttrium-90 resin micro-
spheres radioembolization for liver-limited metastatic colorectal cancer
refractory to standard chemotherapy. Journal of Clinical Oncology 2010;
28(23): 3687-3694.
2. Van Hazel G, Blackwell A, et al. Randomised phase 2 trial of SIR-
Spheres plus fluorouracil/leucovorin chemotherapy versus fluorouracil/
leucovorin chemotherapy alone in advanced colorectal cancer. Journal of
Surgical Oncology 2004; 88(2): 78-85.
3. Gray B, Van Hazel G, et al. Randomised trial of SIR-Spheres plus che-
motherapy vs. chemotherapy alone for treating patients with liver metas-
tases from primary large bowel cancer. Annals of Oncology 2001; 12(12):
1711-1720.
Selective internal radiation therapy
Schematic demonstrating the injection of SIR-Spheres via a catheter inserted
into the groin, with the SIR-Spheres lodging in the small blood vessels which
surround the tumour. Printed with permission SIRTEX
Issue 18 – December 2011 9.

10. MRI-guided, high-intensity focussed ultrasound for
the treatment of cancer
There has been a great deal of interest in the use of MRI-
guided, high-intensity focussed ultrasound (MRgFUS) for the
treatment of indications other than uterine fibroids including
cancer of the breast, liver, prostate, brain and bone. This
summary presented a brief overview of the evidence for these
indications.
HOW IT WORKS
High-intensity focussed ultrasound (FUS) is a non-invasive
means of focusing thermal energy to ablate deep soft tissue
targets such as tumours, which otherwise may only be excised
using open surgery. The high-intensity ultrasound deposits
localised energy, causing rapid vibration of molecules within
the focal spot. This results in localised heating (65-95°C) at the
focal point of the target tissue, avoiding damage to the
surrounding tissue but resulting in tissue necrosis, apoptosis
and cell death of the target. MRI clearly visualises the
boundaries between the normal and cancerous tissue and
when combined with FUS allows for precise targeting of
tumours.1,2
THE EVIDENCE
Breast cancer
MRgFUS allows for accurate targeting of breast lesions for
ablation as the breast may be isolated relatively easily, avoiding
potential damage to other organs and structures. MRgFUS
may potentially be used to replace surgical procedures such as
lumpectomy and wide local incision, in so doing conserving
the breast with the added cosmetic and psychological
benefits.3 Several issues have been identified with the use of
MRgFUS for the ablation of breast cancer, specifically the
importance of adequate tumour-free margins following
ablation and appropriate patient selection. Patients with large
tumours >5cm and those with tumours close to the chest wall
should not be selected.4
A recent review reported on the results of one of the largest
case series of MRgFUS ablation of biopsy-proven breast
cancer to date. Results were presented for 47 out of 57
enrolled women with small breast tumours ≤ 1.5cm with a
distance of more than 1.0cm from the skin. All patients under-
went core needle biopsy 3-weeks after the MRgFUS
procedure. Mean MRgFUS treatment duration was 108
minutes and after a mean follow-up time of 44 months no
local recurrences or significant adverse events were reported.5
Bone cancer
Up to 30% of all cancer patients will develop secondaries in
the bone and approximately half of these patients will go on
to develop pain from these lesions. The current treatment
option for these lesions is radiotherapy; however 20-30% of
patients will gain no relief from pain from radiotherapy and
of those who do experience relief, 27% will have recurring
pain once radiotherapy ceases. Bone actively absorbs FUS
and a large area at the periosteal margin of the bone can be
rapidly heated and in so doing may destroy neural pain fibres
in the periosteum, resulting in palliation of painful bone
lesions.2,6
Several case series were included for assessment in this brief.
All reported good patient outcomes with the majority of pa-
tients experiencing an improvement in pain scores measured
by the visual analogue scale (VAS) or a reduction in pain
medication. Many patients reported a reduction in pain
within 3-days of treatment.7-9
Brain cancer
Previous attempts to use transcranial focused US have been
unsuccessful due to the increase in the acoustic attenuation
of the skull, which is 30-60 times higher than in soft tissue.
To avoid this issue, a hemispherical transducer operating at a
lower frequency to produce the US beam, combined with a
specialised cradle capable of holding the head in place in a
cooling water bath (15-20°C) has been developed.10 There
was limited data available describing the use of MRgFUS for
HealthPACT Bulletin
Positioning of the patient for the treatment of breast cancer with MRgFUS
(printed with permission InSightec Ltd)
10. Issue 18 – December 2011

11. MRI-guided, high-intensity focussed ultrasound for the treat-
ment of cancer continued.........
the treatment of brain tumours, however an interesting
potential use of MRgFUS is for the delivery of therapeutic
magnetic nanoparticles across the blood brain barrier for the
treatment of brain tumours such as gliomas. Low-energy FUS
is used to increase the permeability of the blood brain barrier
in a localised and reversible manner, allowing for the diffusion
of magnetic nanoparticles containing chemotherapeutic
agents. Diffusion of nanoparticles is usually passive, however
the application of an external magnetic force allows
concentration of a therapeutic dose at the target site, with
MRI used to monitor the procedure. The integrity of the
blood brain barrier is re-established within 24-36 hours. To
date only animal studies have been conducted.11-13
Prostate cancer
Phase I and II protocols have been finalised for the treatment
of prostate cancer, with studies set to commence in 2012.
FUTURE STEPS
Based on the low-level, preliminary evidence it would appear
that MRgFUS may be a useful tool for the treatment of pa-
tients with tumours who may have limited treatment alterna-
tives available to them. The range of applications for this tech-
nology are potentially wide-ranging and therefore Health-
PACT have recommended that a New and Emerging Health
Technology Report be commissioned late-2012 to allow suffi-
cient time for the results from the randomised controlled trials
to be published in addition to the publication of initial studies
into the use of MRgFUS for the treatment of prostate cancer
and neurological conditions.
For a copy of the full brief please contact the HealthPACT
Secretariat.
Written by Linda Mundy, HealthPACT Secretariat
HealthPACT Bulletin
REFERENCES
1. Fennessy, F. M. & Tempany, C. M. (2005). 'MRI-guided focused ultra-
sound surgery of uterine leiomyomas', Acad Radiol, 12 (9), 1158-1166.
2. Gedroyc, W. M. & Anstee, A. (2007). 'MR-guided focused ultrasound',
Expert Rev Med Devices, 4 (4), 539-547.
3. Wu, F., ter Haar, G. & Chen, W. R. (2007). 'High-intensity focused ultra-
sound ablation of breast cancer', Expert Rev Anticancer Ther, 7 (6), 823-831.
4. Schmitz, A. C., Gianfelice, D. et al (2008). 'Image-guided focused ultra-
sound ablation of breast cancer: current status, challenges, and future
directions', Eur Radiol, 18 (7), 1431-1441.
5. Brenin, D. R. (2011). 'Focused ultrasound ablation for the treatment of
breast cancer', Ann Surg Oncol, 18 (11), 3088-3094.
6. Dick, E. A. & Gedroyc, W. M. (2010). 'ExAblate magnetic resonance-
guided focused ultrasound system in multiple body applications', Expert Rev
Med Devices, 7 (5), 589-597.
7. Catane, R., Beck, A. et al (2007). 'MR-guided focused ultrasound surgery
(MRgFUS) for the palliation of pain in patients with bone metastases--
preliminary clinical experience', Ann Oncol, 18 (1), 163-167.
8. Liberman, B., Gianfelice, D. et al (2009). 'Pain palliation in patients with
bone metastases using MR-guided focused ultrasound surgery: a multicen-
ter study', Ann Surg Oncol, 16 (1), 140-146.
9. Gianfelice, D., Gupta, C. et al (2008). 'Palliative treatment of painful bone
metastases with MR imaging--guided focused ultrasound', Radiology, 249 (1),
355-363.
10. McDannold, N., Clement, G. T. et al (2010). 'Transcranial magnetic reso-
nance imaging- guided focused ultrasound surgery of brain tumors: initial
findings in 3 patients', Neurosurgery, 66 (2), 323-332; discussion 332.
11. Chen, P. Y., Liu, H. L. et al (2010). 'Novel magnetic/ultrasound focusing
system enhances nanoparticle drug delivery for glioma treatment', Neuro
Oncol, 12 (10), 1050-1060.
12. Liu, H. L., Hua, M. Y. et al (2010). 'Blood-brain barrier disruption with
focused ultrasound enhances delivery of chemotherapeutic drugs for
glioblastoma treatment', Radiology, 255 (2), 415-425.
13. Liu, H. L., Hua, M. Y. et al (2010). 'Magnetic resonance monitoring of
focused ultrasound/magnetic nanoparticle targeting delivery of therapeutic
agents to the brain', Proc Natl Acad Sci U S A, 107 (34), 15205-15210.
Schematic of the procedure demonstrating the localised permeability of the
BBB using FUS flowed by the diffusion of the magnetic nanoparticles, which
are then guided and concentrated by an external magnetic force13
Liver cancer
Invasive radiofrequency or laser ablation has recently been
used as a method to treat local tumours of the liver, with
probes being inserted percutaneously into the target tissue.
Application of power causes local heating followed by the
thermal destruction of tissue. MRgFUS has been suggested
as a non-invasive approach for the destruction of localised
areas of the liver, especially when underlying liver disease is
present, which is common in patients with hepatocellular
carcinoma. MRgFUS of the liver presents technical diffi-
culties due to the presence of the rib cage and movement
of the liver with respiration. Treating patients under
general anaesthesia overcomes the latter problem, however
a MRI-compatible ventilator is required. Currently
MRgFUS treatment can only be applied to areas of the
liver not covered by the rib cage, however it is anticipated
that modified transducers will allow treatment between the
ribs in the near future.2-6
Issue 18 – December 2011 11.

12. Although chest pain may be indicative of myocardial
infarction (MI) there may be many other causes including
indigestion and muscle strain. Patients with MI or acute
coronary syndrome (ACS) should be rapidly and accurately
identified to ensure that the appropriate treatment is
administered. Patients with chest pain are frequently admitted
to hospital until a negative biomarker, eg creatine kinase-MB
test excludes myocardial injury.1 Recently the cardiac
contractile protein troponin has become the preferred and
recommended biomarker.2,3
HOW IT WORKS
Troponin is a complex of 3 structural proteins (C, T and I)
that are integral to cardiac muscle contraction and are released
when cardiac myocytes are damaged. The higher the
concentration of troponin in the blood, the greater the dam-
age to the cardiac muscle. As such levels of troponin may be
used to diagnose MI in the presence of ischaemia.
Conventional troponin testing requires serial blood sampling
over a 6-12 hour period. High-sensitivity immunoassays
measure very low concentrations of troponin, allowing
diagnosis or exclusion of MI/ACS to occur earlier, thereby
expediting discharge in patients who test negative for an acute
cardiac event. Conversely, the increased sensitivity of these
assays may lead to an increase in hospital admissions, due to
the detection of lower, previously undetectable levels of
troponin that may not necessarily be due to MI.1,2 A positive
troponin result should be followed up by a search for an
alternative plausible diagnosis and/or cardiac consultation if
ACS is suspected in the context of the clinical presentation.4
THE EVIDENCE
Three non-randomised comparative studies were included for
assessment in this brief.5-7 Only the results of the largest study
are presented, however for a copy of the full brief please
contact the HealthPACT Secretariat.
1,818 consecutive patients presenting with chest pain and a
high pre-test probability of acute MI were recruited in a multi-
centre study. Troponin levels were measured and compared at
the time of admission to hospital, and at 3 and 6 hours post-
admission. Primary diagnosis was based on conventional
troponin assays, using Roche Troponin T or Siemens
Dimension RxL Troponin I. These conventional troponin I
assays were used only for the diagnosis of MI and not for
comparison with the sensitive troponin I assay. The final
diagnosis at discharge was based on all available clinical,
laboratory and imaging findings. A total of 413/1818 patients
(22.7%) had a final discharge diagnosis of acute MI, including
130 patients (7.2%) who presented with MI with ST-segment
elevation. The diagnostic accuracy of sensitive troponin I was
highest, with an area under the receiver-operating-
characteristics curve of 0.95 within 3 hours of presentation of
symptoms and 0.96 by 6-12 hours follow-up. The sensitivity
and specificity of sensitive troponin I was 90.7% and 90.2%,
respectively, compared to 72.7% and 94.1% for the standard
troponin T tests. Using the sensitive troponin I assay, 88% of
MIs were detected on admission in patients presenting 6 hours
after the onset of symptoms, and 95% were detected in those
presenting between 6-12 hours after the onset of symptoms.6
FUTURE STEPS
HealthPACT noted the concerns raised by the evaluators
regarding a potential conflict of interest of the authors of the
studies included for assessment. Based on the uncertainty
surrounding the potential advantages and disadvantages of
using high sensitivity troponin assays for the routine diagnosis
of MI, HealthPACT have recommended that the technology
be monitored for 12-months, awaiting the potential
publication of higher quality, preferably randomised, trials
become available could provide clarity in regards to the risk/
benefit profile for the use of the technology
Written by Deanne Forel from ASERNIP-S
HealthPACT Bulletin
REFERENCES
1. Baker JO, Reinhold J, Redwood S, Marber MS. Troponins: redefining their
limits. Heart 2011;97(6):477-452.
2. Masson S, Latini R, Anand IS. An update on cardiac troponins as circulat-
ing biomarkers in heart failure. Current Heart Failure Reports 2010;7(1):15-21.
3. Omland T. New features of troponin testing in different clinical settings.
Journal of Internal Medicine 2010;268(3):207-217.
4. Chew DP, Aroney CN, Aylward PE et al. 2011 Addendum to the National
Heart Foundation of Australia/Cardiac Society of Australia and New
Zealand Guidelines for the Management of Acute Coronary Syndromes
(ACS) 2006. Heart, Lung and Circulation 2011;20(8):487-502.
5. Aldous SJ, Florkowski CM, Crozier IG et al. Comparison of high
sensitivity and contemporary troponin assays for the early detection of
acute myocardial infarction in the emergency department. Annals of Clinical
Biochemistry 2011;48(3):241-248.
6. Keller T, Zeller T, Peetz D et al. Sensitive troponin I assay in early diagno-
sis of acute myocardial infarction. New England Journal of Medicine 2009;361
(9):868-877.
7. Reichlin T, Hochholzer W, Bassetti S et al. Early diagnosis of myocardial
infarction with sensitive cardiac troponin assays. New England Journal of
Medicine 2009;361(9):858-867
High sensitivity troponin assays for the diagnosis of
myocardial infarction
12. Issue 18 – December 2011

13. The Regulatory Standards for the approval of Medical Devices in Australia
The Senate Standing Committee on Community Affairs completed its Inquiry into "The Regulatory Standards for the Approval of
Medical Devices" and tabled its report in the Senate on 22 November 2011. The Report (including its 18 Recommendations) can
be found at: http://www.aph.gov.au/Senate/committee/clac_ctte/medical_devices/report/index.htm
HealthPACT Bulletin
News round-up
Technology Key Messages
Aerosol-Generating Procedures and Risk of
Transmission of Acute Respiratory Infections :
A Systematic Review
Very low-quality evidence suggests that some procedures potentially capable of
generating aerosols have been associated with increased risk of SARS
transmission of SARS-CoV from infected patients to HCWs, with the most
consistent association across several studies being with tracheal intubation.
Email and Electronic Communication of Patient
Information: Clinical Evidence and Guidelines
Evidence suggests that email or electronic communication use between health-
care providers and patients is beneficial and improves communication; how-
ever, there are concerns about confidentiality and security, and inadequate ad-
herence to recognised guidelines
Wireless Nurse Call Technologies: Clinical
Evidence and Guidelines
The evidence suggests the use of wireless nurse call technologies in acute and
long-term health care facilities can improve overall clinician-clinician and
clinician-patient communication as well as increase clinician response times.
Screening and Diagnostic Tests before Endo-
scopy: Clinical Evidence and Guidelines
Although faecal occult blood testing in patients at-risk for neoplasia is useful in
preventing unnecessary colonoscopies, the evidence suggests that the identified
alternatives to endoscopy for adult dyspeptic patients are less effective than
initial endoscopy. Evidence-based guidelines recommend that standard tests
and screening for patients before undergoing endoscopy be performed based
on perceived level of risk for the patient; adults over 50 years of age with
dyspepsia should undergo endoscopy.
CADTH Rapid Response Service
The Canadian Agency for Drugs and Technologies in Health (CADTH) provides a Rapid
Response Service with a range of products e.g. a reference list or summary with critical
appraisal. An excerpt of their Summary for November 2011 is shown below. For more
information, see http://www.cadth.ca/en/products/rapid-response/2011/06?
In September Singapore’s Agency for Science, technology and Research (A*STAR) and
the NHMRC signed a Memorandum of Understanding to promote exchange between
the 2 countries in the areas of health and medical research. Under the MOU, the 2
agencies will fund collaborative research projects in areas such as emerging infectious
diseases, regenerative medicine, non-communicable diseases, bioinformatics and
nanotechnology. In addition, scientific symposia will provide a platform for researchers
from both countries to share their latest research and a forum to establish networks. The
first symposium is scheduled to take place in Australia in 2012.
In 2011, the NHMRC is celebrating 75 years of enabling health and medical research in Aus-
tralia. To celebrate this milestone, a 3-day scientific symposium titled, Research for a Healthy
Future, was held in Canberra. The Symposium was attended by approximately 200 out-
standing early to mid-career researchers, nominated by their institutions as future research
leaders with some Australia’s leading researchers, including Nobel Laureates Professors Peter
Doherty and Ian Frazer, as key-note speakers. Themes discussed included the challenges
facing health and medical researchers across the globe such as combating non-communicable
disease, collaborating to ensure health policy and practice is evidence-based, and providing
for the health needs of the present while planning for the future. Topics within this scope
included mental health and dementia; patient care, policy and practice; and economic and
industry benefits of health and medical research as well as a broad examination of the future
of health and medical research.
A copy of the symposium handbook can be accessed via this link in addition a video
presentation of many of the speakers may be accessed here.
Issue 18 – December 2011 13.

14. HealthPACT Bulletin
For more news on the 2012 HTAi Conference go to the web site of the meeting: http://www.htai2012.org,
or follow news and be updated through the social networks:
Facebook https://www.facebook.com/pages/HTAi-Bilbao-2012/246259402058890 and
Twitter http://twitter.com/#!/htai2012.
The theme for HTAi 2012 is “HTA in integrated care”. The conference hopes to share and discuss the experiences of
health care practitioners, researchers, policy makers, industry representatives, consumer and patient organisations
and other stakeholders as they grapple with new technological innovations, challenges and solutions being developed
to integrate health care.
14. Issue 18 – December 2011

15. Other New and Emerging
Technologies
The following technologies were also considered by the
Health Policy Advisory Committee on Technology
(HealthPACT) in August 2011.
Regional hyperthermia for soft-tissue sarcoma
90Y-Zevalin for the treatment of non-Hodgkin's lym-
phoma
And in November 2011
Peripheral Vascular Stents including drug-eluting
balloons
Percutaneous Venoplasty
An update of Implantable Baroreflex Stimulation for
Hypertension
An update of Rapid Tests for Chlamydia
An Update of Extracorporeal Shockwave therapy for
the treatment of angina
For copies of these briefs please contact the Health-
PACT Secretariat
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
14. Issue 18 – December 2011
HealthPACT Bulletin
PRODUCTION NOTES
The HealthPACT Bulletin is published by its Secretariat on
behalf of the Health Policy Advisory Committee on
Technology (HealthPACT) and funded by the Australian
Government Department of Health and Ageing.
Sources of many articles herein are reports prepared by
Adelaide Health Technology Assessment (AHTA) and the
Australian Safety and Efficacy Register of New Interven-
tional Procedures – Surgical (ASERNIP-S) who were con-
tracted to support HealthPACT’s work.
- - - - - - - - - - - - - - - - - - - - - - - -
Editors: Elizabeth Garrigan and Linda Mundy
Design: Elizabeth Garrigan and Linda Mundy
Writers/Information Specialists:
Linda Mundy, Ben Ellery, Deanne Forel, Heath White,
Prema Thavaneswaran and Yasoba Atukorale.
Contact:
Manager, HealthPACT Secretariat
c/o Access Improvement Service, Centre for Healthcare
Improvement, Queensland Health
Citilink Business Centre,
Lobby 2, 153 Campbell Street, Bowen Hills, QLD 4006
email: HealthPACT@health.qld.gov.au
Tel: +61 7 3239 6483
Fax: +61 7 3405 6108
- - - - - - - - - - - - - - - - - - - - - - - -
Please forward any feedback on this Bulletin or advice re-
garding medical or surgical technologies, procedures, or
health programs that are new or emerging in Australia to:
Tel: +61 7 3239 6483
Email: HealthPACT@health.qld.gov.au