OBJECTIVES: Recommendations from Australia’s Medical Services Advisory Committee (MSAC) provide advice to the Minister of Health to inform reimbursement decisions regarding medical services. This paper aims to address gaps in literature on analysing trends regarding MSAC’s recommendations as well as key drivers for rejection and acceptance to help improve submission quality.

METHODS: Data from Public Summary Documents from 2016 to 2022 were retrieved and qualitatively analysed for decision outcomes based on categories like therapeutic area and service category. Rejected or deferred applications were further evaluated and categorized based on reasons like insufficient evidence and low cost-effectiveness. First-time submissions (FTS) between 2021-22 that received positive outcomes were also evaluated for key drivers for acceptance.

RESULTS: During this period, there were 244 submissions with modest variations in the number of applications per year. Most of these were diagnostics (mainly oncology) followed by treatments, programs, and devices. 53% had a positive outcome, 74% of them being FTS. 34% were rejected and 13% deferred.

CONCLUSIONS: This analysis shows that MSAC has a high rate of recommending FTSs for reimbursement. Findings provide unprecedented evidence on most common reasons for rejection (and potential drivers for acceptance. The inclusion of Value of Knowing (non-health outcomes) in several submissions indicates MSACs recognition that the value of a medical technology often extends beyond standard clinical and economic criteria.