Infections in the brain and spinal cord (central nervous system [CNS] infections) can be caused by bacteria or viruses. In Australia, meningitis and encephalitis are the common CNS infections in children [165, 166]. These infections have affected more than 4,000 children in Australia over the past 10 years [167, 168]. They can be very serious, leading to an increased risk of death and long term complications, such as cognitive impairment (e.g., memory problems), seizures and loss of vision [169-171]. Prompt medical assessment and treatment for children are critical for survival [169-171]. Treatment must begin immediately with broad-spectrum antibiotics, and once the exact cause is determined, a more targeted therapy should be initiated [171]. To diagnose CNS infections, a sample of the cerebrospinal fluid (the fluid surrounding the brain and spinal cord) is taken for laboratory analysis [172]. However, traditional diagnostic methods require 1 to 3 days to determine the exact cause of infection. This delay means that broad-spectrum antibiotics or anti-virals are used for longer than needed, increasing the child’s risk of adverse events, lengthening their hospital stay and accelerating the development of microbial resistance to antibiotics [166, 171]. While only one of many cases in which antibiotics are used, current projections indicate that antimicrobial resistance could cost the Australian healthcare system $370 million by 2050 [173]. Treatment options vary depending on the cause of infection, and the overall health of the child. On average, children with a CNS infection stay in the hospital for 6 days, and each day in hospital costs $1,816 [174, 175]. However, if the exact cause of infection is determined faster, children’s health outcomes can be improved and both the length of stay in hospital and its costs can be reduced.

As a countermeasure to the shortcomings of traditional diagnostic methods requiring long incubation times (1-3 days), the Multiplex Polymerase Chain Reaction Meningitis and Encephalitis Panel (multiplex PCR test) was developed [166]. The multiplex PCR test can effectively detect up to 14 potential pathogens of meningitis and encephalitis from a single cerebrospinal fluid sample within 1 hour [166, 171]. The utilisation of this rapid diagnostic tool can lead to significant benefits such as reduced broad-spectrum antibiotic usage, anti-viral usage, shorter hospital stays, and lower hospital costs [166, 171].

The effectiveness of the multiplex PCR test in children with CNS infection was compared to traditional diagnostic methods in patients in the Top End region of the Northern Territory, Australia. The impact of the multiplex PCR test in terms of reduction in hospital length of stay was assessed [166]. The impact, however, could be even more significant than that seen in the Northern Territory trial as the multiplex PCR test was not performed immediately after the cerebrospinal fluid was obtained [166]. Had the test been performed immediately, there would have been an even larger improvement in time to determine the exact cause and length of hospitalisation [166]. For example, a study conducted at Australian Capital Territory Pathology estimated that median turnaround time for the multiplex PCR test was 2.9 hours, compared to 21.1 hours for traditional laboratory testing [178].

Hepatitis C (HCV) is a viral infection that affects the liver. HCV is spread through contact with infected blood. This can happen through sharing needles or syringes, or from unsafe medical procedures such as blood transfusions with unscreened blood products. [150] About 70% of people with HCV develop a chronic (long term) illness. The prolonged infection can lead to severe liver damage, including scarring (cirrhosis) and liver cancer, which can be life threatening. [150] In Australia, over 115,000 people live with chronic HCV, with many unaware of their status [151]. In 2021 alone, Australia saw 7,487 new cases [152], with higher rates in rural and regional areas [152] and among the Aboriginal and Torres Strait Islander communities. Although no vaccine exists for HCV, there are effective new treatments known as direct- acting anti-virals (DAAs). These treatments are available in Australia and can not only treat but cure the disease [150, 153]. With a curative treatment available, WHO has set a goal to eliminate HCV virus infection by 2030. However, Australia’s ability to reach this goal is threatened by declines in HCV testing and treatment globally. The main obstacle to increasing HCV diagnosis and treatment is the current diagnostic process, which often requires approximately five visits and up to 4 weeks before receiving a diagnosis. This can result in many people being lost to follow-up. This problem is particularly pronounced in key target populations, such as people who inject drugs, individuals in prisons and Aboriginal and Torres Strait Islanders. [154] If testing and treatment continues to decline, between 2016-2030, it could cost $3.01 billion in direct health costs (treatment, testing and disease management), and $26.14 billion in lost productivity and premature deaths [155].

Timely diagnosis and treatment of HCV is critical to achieve the WHO elimination goal [14]. Traditional testing pathways involve an HCV antibody test to confirm exposure and an HCV RNA test to detect active infection [154], thus requiring multiple visits before gaining a diagnosis. Recent advancements, and availability of finger-stick POC testing has changed clinical management, making it easier and faster to diagnose and treat patients. The HCV POC tests is accurate [156] and can detect an infection within one hour [154]. The test enables rapid diagnosis and treatment in a single visit, rather than in five visits with conventional testing methods. Patients being lost to follow up is therefore significantly reduced. With the introduction to HCV POC tests, it has facilitated high HCV treatment uptake in needle and syringe programmes (78%) [157], medically supervised injecting rooms (89%) [158], mobile outreach models (74%) [159], and prisons (93%) [159].

Building on the success of the POC testing for COVID-19 implemented with remote Aboriginal and Torres Strait Islander communities (see COVID-19 case study), the National Australian HCV POC Testing Program was funded by the Australian Government. HCV POC testing was made available at sites with high-risk individuals, such as drug treatment clinics, needle and syringe programmes and prisons. The test as well as the cure was therefore brought to the person. [154] In 2022, 5,733 POC tests were performed and 14% of people were identified as having a current HCV infection [154]. Within the program, it is estimated that 75% of those diagnosed were able to begin immediate treatment, , compared with the 26% to 60% initiation rate seen with conventional testing, which often occurs with a substantial delay [154, 160]. This rapid and efficient POC testing facilitated a broad reach, allowing a large number of individuals to be tested and treated swiftly, providing many with the opportunity for a cure [161]. As a result, it is estimated that the program saved approximately 9 to 29 additional lives, compared to conventional testing methods. These life-saving results and the associated costs were calculated using the best publicly available evidence and more comprehensive analyses are required to determine the full value of the program. Furthermore, while not factored into the cost savings, the average cost to identify patients and initiate HCV treatment via POC testing is estimated to be up to 35% less than that of traditional testing methods [162].

The coronavirus disease of 2019 (COVID-19) was declared a worldwide pandemic in March 2020. Since then, multiple waves have infected over 11.5 million Australians and caused over 22,700 deaths [139]. COVID-19 is highly infectious and results in a wide range of symptoms. While many people experience mild symptoms, some can become seriously infected and are hospitalised. For patients who are hospitalised, 3% require admission to the ICU. [140] Older people and those with pre-existing medical conditions like cardiovascular disease have a higher risk of severe disease [139, 140]. First Nations people in remote communities, who experience a burden of disease that is 2.3 times the rate of non-Indigenous Australians, are also more likely to be affected by COVID-19 [141]. Extensive and rapid public health measures – such as contact tracing, physical distancing, testing and subsequent isolation – were employed as a response to the pandemic [140]. While these measures allowed Australia to avoid many of the worst effects of COVID-19 seen abroad, the pandemic still had, and continues to have, major impacts on the health and wellbeing of the community [142-144]. COVID-19 is estimated to have cost the economy $158 billion and a number of shortcomings in Australia’s response to the pandemic have contributed to this huge cost [32]. Insufficient planning, inadequate infrastructure, and a lack of national coordination of public health measures reduced our capacity to respond in a timely and efficient manner. Further investment in these areas is critical to ensure the healthcare system is ready to face the challenges that the next pandemic will bring [142].

COVID-19 is a highly infectious disease that presents significant risks to First Nations people in rural, regional or remote communities. These communities are already at a higher risk of poor health due to a history of colonisation, multiple underlying conditions, limited access to medical facilities and challenges in isolating from others [145]. As laboratory services that test for COVID- 19 can be hundreds of kilometres away for many of these communities, molecular POC testing is particularly beneficial. Molecular POC testing enables swabs to be tested for the virus within the health service by trained health care staff and provides an accurate result within 45 minutes [141]. Performing a Nucleic Acid Amplification Test to detect viruses, such as COVID-19, the technology can also be used to detect the presence of bacteria such as tuberculosis [145-147]. Molecular POC testing technologies aim to intervene at every stage of the disease to quickly and accurately identify infected patients [145-147]. This technology has played a key role in containing the multiple COVID-19 outbreaks in Australia [145-147]. The Aboriginal and Torres Strait Islander COVID- 19 POC Testing Program was established in March 2020 as an immediate response to the pandemic. The Program was implemented under the governance of the National Aboriginal and Torres Strait Islander COVID-19 Advisory Group and led by The Kirby Institute University of New South Wales (NSW) and Flinders University International Centre for POC Testing. It involved molecular POC testing delivered within remote health clinics to First Nations communities, run by Aboriginal Community Controlled Health Services and state/territory health services [145, 146, 148]. The provision of molecular POC testing enabled COVID-19 to be identified, treated, and contained in a quick and accessible way to prevent widespread community transmission [145-147].

An evaluation of the Aboriginal and Torres Strait Islander POC Testing Program demonstrated its effectiveness in delivering fast and accurate on- site molecular POC testing when rapid antigen tests were not yet available in Australia. Molecular POC testing enables swift initiation of public health interventions, including rapid community vaccination programs, to help prevent the potentially severe health impacts of COVID-19. [145] Without this testing program, people would have had to wait around 6 days for a result from a centralised laboratory. However, because the Program was funded in a timely fashion, the opportunity to identify positive cases was maximised, enabling effective contact tracing and breaking the link in transmission. It is estimated that in the first 40 days from the first case being identified, between 23,000 and 123,000 infections were averted as a direct result of the Program. [145] Molecular POC testing also provided protection for those at particularly high risk of developing severe illness, by early identification of a positive case. It is estimated that at least 83,000 hospitalisations and 6,319 ICU admissions due to COVID-19 infection were avoided over 2 years because of POC testing, and around 16,875 medical evacuations were also likely to have been avoided. [145] Prior to the implementation of molecular POC testing, some remote communities were chartering flights to transport swabs and symptomatic individuals to the nearest town to isolate while waiting on a test result. The prevention of this air travel through POC testing would have also significantly benefitted the environment through a reduction in carbon emissions. [145]

During surgeries, organ transplantation, childbirth, or when there has been a car accident or other injury, there is a risk of heavy bleeding [179]. When a person bleeds heavily (known as a major haemorrhage), patients require administration of large volumes of blood [179]. Managing these events can be complex, and is life threatening for patients [180]. In Australia between 2011 and 2015, almost 1 in 5 patients receiving a massive transfusion did not survive [102]. Blood, a vital natural resource, forms the cornerstone of our healthcare system [181]. Blood is generously donated, and excessive blood use places a huge burden on health expenditures. Australian annual expenditure on blood products is staggering, exceeding $1.2 billion [181, 182]. Each unit of red blood cells costs around $412 [183]. Inclusive of hospital expenses, a single transfusion could cost over $1,000 per patient. [183] Appropriate use of blood not only conserves this invaluable resource but also minimises health complications such as allergic reactions and the potential of disease transmission. With 29,000 donations made weekly in Australia, blood transfusion is a common therapeutic procedure, however it is frequently overused. Excessive blood usage and its impact on patient outcomes emphasise the importance of Patient Blood Management (PBM) programs, especially in a world where healthcare budgets are tightening as the population is ageing. [183]

PBM is aimed at enhancing clinical outcomes by reducing unnecessary use of scarce blood supplies [184, 185]. POC coagulation tests are important in achieving the aims of PBM as the test provides detailed information in only 5 to 20 minutes, enabling fast and targeted treatment decisions [186]. In comparison, conventional coagulation tests offer limited information and targeted treatment decisions take between 40 to 60 minutes [186]. The World Health Organization strongly supports the adoption of POC coagulation tests as part of PBM, highlighting its ability to guide healthcare professionals in blood product selection, expedite outcomes, reduce reliance on donor products, and prioritise patient-centred care [185]. Although Australia pioneered this domain, its adoption of POC coagulation tests has been slow. Queensland and Western Australia have incorporated this technology into their care, but not all states have followed suit. One reason is that the POC coagulation tests are more expensive than conventional tests. While pathology budgets incur the full expense of these tests, the broader benefits and cost savings of faster and more detailed testing to the wider healthcare system are not accounted for within the pathology budget. POC coagulation tests have therefore not been consistently funded across states, despite the clear benefits to patients and the healthcare system as a whole.

The world’s largest study on the impact of implementing a PBM program and adopting POC coagulation testing was conducted in Western Australia. The study included 600,000 patients admitted to Western Australia’s four major adult hospitals between 2008 and 2014. Over the six-year study period, the program was associated with healthcare system and resource savings with a significant reduction in the use of blood and long-term improvements in patient outcomes. [187]

Heart failure is a condition that occurs when the heart begins to function less effectively at pumping blood around the body [24]. It can occur suddenly (acute) but usually develops slowly (chronic) as the heart gradually becomes weaker [25]. Symptoms can include breathlessness, fatigue, and swollen ankles or legs [26]. More than 102,000 people are living with heart failure in Australia. Aboriginal and Torres Strait Islander people are three times more likely to be diagnosed than non-Indigenous people. Older individuals and people of lower socioeconomic status are also at an increased risk [25]. Diagnosis of heart failure is often delayed, with most patients receiving their first diagnosis after being hospitalised [27, 28]. General practitioners (GPs) face significant challenges in diagnosis as there is no single test to confirm (or rule out) heart failure. Instead, a combination of tests is recommended including an echocardiogram (echos), physical examination and blood chemistry assessments [26, 29]. Around 25%– 35% of people with suspected but uncertain heart failure have heart failure [30, 31]. This means a significant number of people are being incorrectly diagnosed and are receiving suboptimal care, resulting in the inefficient use of scarce healthcare resources [32]. Echos are used to show how blood flows through the heart and heart valves and are used to confirm the diagnosis of heart failure [33]. Unfortunately, long wait times and the location of echo centres can also make accessing these services difficult, particularly for Aboriginal and Torres Strait Islander people and those living in rural areas [34, 35]. Given this potential delay, GPs often refer their patients to specialists (cardiologists) or the emergency department (ED) [29]. Despite efforts to improve quality of life and survival, heart failure has poor patient outcomes. Around 50% of people with heart failure die within 5 years of diagnosis, worse than many cancers [36]. Combined, heart failure and cardiomyopathy contributed to 15% of all deaths in Australia in 2021 [25]. As the population continues to age, the number of people living with heart failure is likely to increase, demanding additional resources for detection and treatment [36]. An estimated $2.68 billion per year is currently spent on the management of heart failure [36]. Improving the time to diagnosis and subsequent initiation of treatment, along with quickly ruling out heart failure in the primary care setting, will help reduce this huge financial cost and improve patient outcomes [37-41].

NT-proBNP is a fast and accessible test that allows GPs to accurately rule out heart failure [26, 42]. It consists of a blood test that measures the protein N-terminal pro-b-type natriuretic peptide (NT-proBNP), produced when the muscles of the heart are stretched [43]. The test is performed via laboratory analysis, which provides a result in 3 days. However, there is also a POC test that returns a result in only 12 minutes [44]. NT-proBNP is currently funded in public hospitals and used in the ED and, because of this, many public patients are referred to the ED by their GP. This avoids the longer wait time for an echo in the primary care setting and out of pocket costs for patients accessing it through their GP or specialist. The test therefore has potential for significant benefit in reducing the unnecessary use of echos and visits to ED if made available to GPs [26, 40]. The test is recommended by Australian heart failure guidelines and is both recommended and widely available in the primary care setting in the UK [26, 45]. However, in Australia, access to NT-proBNP in the GP setting is not yet available despite the test being approved for use in Australia since at least 2003. [46].

Access to NT-proBNP in the GP setting can speed up the process of diagnosing or ruling out heart failure. Instead of referring patients with suspected or uncertain heart failure to the ED, a GP can carry out their own investigation to rule out the condition and shift their focus to more appropriate use of services and referrals [26]. A reduction in unnecessary echos for people who are found to not have heart failure, ED visits and subsequent hospitalisations from ED visits is expected to lead to a reduction in spending for the Government on these services, while reducing demand on the ED. Patients with suspected or uncertain heart failure can also experience a positive impact. Not having to miss work for a visit to the ED and avoiding the out of pocket costs for unnecessary echos can result in significant cost savings. Family and friends, who often accompany patients to the hospital, will also benefit by not missing out on their potential earnings. In a workforce already facing shortages this takes a significant toll on businesses, the services they can provide and their ability to remain open. Moreover, this reduction in income loss can contribute to a boost in Government revenue through taxation. NT-proBNP can improve time to diagnosis, leading to earlier treatment initiation. This could improve long term patient outcomes, reduce early death, and offer the broader population the advantages of a more efficient healthcare system [27, 28, 45]. Conservatively this extrapolation was excluded from the model. Although difficult to quantify, a reduction in unnecessary investigations such as referral for echo also reduces CO2 emissions. This is important when considering the environmental impacts of healthcare [47].

Unleashing the Hidden Potential

Reframing Pathology Technology's Role in Australian Healthcare

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EXECUTIVE SUMMARY

Pathology testing and technology underpins every aspect of our medical system. It plays a vital role across all facets of healthcare throughout our lives by providing crucial diagnostic information, enabling the selection of proper treatments, aiding in choosing preventive actions, and offering vital data to enhance care management.

Pathology technology is a rapidly evolving area, continuously offering faster, more informative results for patients who have access to these innovations. Faster integration of these innovative technological advances enables the creation of a better, more robust healthcare system that optimises patient-centred care in every instance, regardless of geography, age, and socioeconomic status. Failure to appropriately invest in and fund this innovative technology in a timely fashion impacts the present-day quality of our healthcare system. Our future capability is enhanced by integrating new advancements to upgrade the care we provide to Australians.

As Australia’s population ages and the risk of chronic diseases, cancer, and new infections or pandemics rise, the Australian healthcare system and those around the world are navigating challenges to address the unmet healthcare needs of patients. At the same time, Governments have a responsibility to ensure that healthcare spending remains sustainable while providing equal access to high-quality care.

Our failure to recognise the broader value of pathology technology is resulting in stagnant funding processes and slow adoption of innovative technologies that includes genomics, point of care and digital health. Intangible value, such as the value of knowing and the value of community, are overlooked. There is also inadequate consideration of the cost and realised value that shifts between federal jurisdictions and that of States and Territories. The complexity of these factors results in a lost opportunity to measure the true impact of life-changing technology.

We have an opportunity to invest and provide Australians with timely access to such technology so that Australia does not miss out on direct savings to the healthcare system and the broader social and economic benefits that pathology technology has to offer.

This Health Economic Report shines a light on the true value of pathology technology to health consumers, healthcare providers and to our economy. Providing an evidence base to catalyse the significant change we need to evolve how healthcare is delivered in Australia. The pathology technology revolution affords an opportunity to move from a sickness to a wellness focused healthcare system. We can identify health conditions earlier, initiate treatment sooner and keep people healthy and productive.

While this report highlights just a handful of cases, the underlying technologies address a broad range of conditions, from cancers to mental health, contagions, and antibiotic resistance, as well as in the optimisation of therapeutics for targeted care. There is substantial opportunity to change the way healthcare is delivered, and now is the time to embrace this change.

$7.0 BILLION
in value FORGONE over 2-20 years

CHILDREN WITH SUSPECTED GENETIC CONDITIONS

The high cost of delaying access to innovative genomic tests: Whole exome/genome sequencing.

Next generation sequencing techniques such as whole exome sequencing, whole genome sequencing and rapid whole genome sequencing have revolutionised the diagnosis of rare genetic conditions and continue to rapidly advance in their speed and accuracy. Barriers preventing faster access to these diagnostic technologies has resulted in a loss of over $529.6 million in value over the past 5 years.

Realise the value with a diagnostics expert advisory body.

$15.2 M

in benefits forgone by patients with suspected genetic conditions through better access to support and special education services.

$152.4 M

in benefits forgone by parents of children with suspected genetic conditions through reduced productivity loss, the value of knowing, improved mental wellbeing, increased opportunity for cascade testing and reduced out of pocket costs.

$361.9 M

in benefits forgone by the Government through reduced spending on appointments, tests, treatments, reduced hospital length of stay and mental healthcare services, as well as reduced lives lost.

Having the right test at the right time for known cardiovascular conditions can be life changing

SUSPECTED HEART FAILURE IN THE GP SETTING

Optimising the utilisation of scarce healthcare resources: NT-proBNP.

The delay in providing access via MSAC to NT-proBNP in the GP setting has resulted in an estimated loss of $5.9 billion in value over the past 20 years that could have positively impacted patients, their carers and the Government.

Realise the value with an accelerated funding model

$50.6 M

in benefits forgone by patients with suspected heart failure through reduced productivity loss and reduced out of pocket costs.

$26.2 M

in benefits forgone by friends/family of patients with suspected heart failure through reduced productivity loss.

$5.8 B

in benefits forgone by the Government through a reduction in ED visits and subsequent hospitalisations, reduced echocardiograms and increased government taxation revenue.

Preeclampsia is still considered an immediate risk and danger for 6 weeks after birth, but its impact on my brain and my body would last much longer than that...

PRE-ECLAMPSIA

Unlocking better pregnancy outcomes while reducing healthcare expenditure: the pre-eclampsia (PE) ratio test.

The delay in providing access to the PE ratio test in Australia means the broader value of the test is not being realised, especially when considering that the test was TGA approved in 2011. An estimated loss of $235.3 million in value has been forgone to the Government over the past 12 years as a result of this delayed access.

$235.3 M

in benefits forgone by the Government through a reduced hospital admissions.

OVARIAN CANCER

Improving efficiencies within the healthcare system: HRD test.

The delay in providing access via MSAC to HRD testing for women with newly diagnosed ovarian cancer who are BRCAwt HRD positive has resulted in an estimated loss of $319.1 million in value over the past 2 years that could have positively impacted patients, their carers and the Government.

Realise the value with an accelerated funding model.

$3.7 M

in benefits forgone by patients with BRCAwt HRD+ ovarian cancer in reduced palliative care costs, reduced productivity loss and improved mental health.

$4.4 M

in benefits forgone by friends/family of patients with BRCAwt HRD+ ovarian cancer through reduced informal care and improved mental health.

$310.8 M

in benefits forgone by the Government through avoided deaths and increased tax revenue.

$160.9 K

in benefits forgone by the employers of carers to patients with BRCAwt HRD+ ovarian cancer through reduced presenteeism.

$1.8 BILLION in POTENTIAL value over 10 years

COVID-19

Towards health equity: COVID-19 point of care (POC) test.

The more infectious a disease and the more remote a community, the more valuable POC testing becomes. The provision of POC testing during a global pandemic when the effects of a viral infection were largely unknown enabled the protection of communities who may have otherwise been hard to reach. The implementation of the POC testing program in a swift manner ensured that the true value of the POC test was realised, saving the Government $112 billion over two years.

$337 M- $1.8 B

in benefits gained by the Government through a reduction in COVID-19 infections which prevented the cost of hospitalisations, ICU admissions and medical evacuations.

HEPATITIS C INFECTION (HCV)

Single visit, lasting cure: HCV POC test.

There is a cure available for those diagnosed with HCV. However, it relies on detection of the infection. The value of a cure can be realised with access to the HCV POC test. Access holds the potential to save lives and enhance health outcomes, saving the Government $1.9-6.2 million per year in lives saved. This can also bring us closer to achieving the WHO’s goal of HCV elimination by 2030.

$1.9- $6.2 M

in net benefits gained by the Government through the avoidance of between 9 and 29 HCV deaths as a result of the implementation of the HCV program for one year.

MENINGITIS AND ENCEPHALITIS

Timely diagnostics, tangible savings: the multiplex polymerase chain reaction (PCR) test.

The impact of the multiplex PCR test is far- reaching. Multiplex PCR testing in children with CNS infections enables access to the right treatment at the right time, helping to ensure antibiotics are used appropriately and reducing the risk of death, illness and time spent in hospital. Providing access to multiplex PCR testing could result in the creation of $35.2 million in value over 10 years.

$35.2 M

In potential benefit to the Government through the reduction in hospital length of stay.

MAJOR BLEEDING

Save lives with less blood: POC coagulation test.

The POC coagulation test as part of patient blood management has the potential to enhance healthcare delivery and optimise resources throughout Australia, moving beyond the specific states or hospitals that currently use it. With faster and more precise treatment decisions, the POC test improves patient health outcomes and reduces medical expenditures, resulting in the creation of between $1.4 and $1.8 billion in value over 10 years if adopted nationally.

$1.4-$1.8 B

In potential value to the Government through the reduction in blood product utilisation, hospital length of stay and transfusion administration.

CALL TO ACTION

As stated in the recent Intergenerational Report, “Australia’s ability to meet challenges while seizing future opportunities depends on choices made today”. This report highlights the forgone value and cost to the health economy of delaying access to high-medical value tests and technology. Unlocking the true value of pathology technology for the patients of today will reduce the pressures on the future of healthcare. If a forward-thinking mindset is adopted, Australia can achieve better patient care at a lower total cost with a more robust healthcare system.

At the heart of moving Australia to a wellness-based health economy is the realisation of the full value offered by pathology technology. There is forgone value in the tests and technology that are available today – but not funded and therefore rarely used – and the innovative new technology rapidly piling up at our doorstep. The patient, societal and economic benefits from these technologies, currently unrealised, can be unlocked in several very clear ways:

Establish a Diagnostic Advisory Group with stakeholders including healthcare professionals and laboratory service providers, patient advocacy groups, industry bodies, and Government representatives.
Draw on the Advisory Group for the formation of a National Diagnostics Strategy and Roadmap
Use the Strategy to guide a range of critical activities such as sovereign supply, stockpile and manufacturing; purposeful R&D and horizon scanning for high-medical value technology; adjudication on accelerated access pathways to fund high-medical value technologies; identification of technology needs for Australia’s key healthcare programs, working with manufacturers to ensure objectives of the programs are met.
Use the Advisory Group in an ongoing capacity to provide input on future direction of the Strategy.
In the short term, the Group could identify currently available, but underutilised, high-medical value tests and technology for accelerated pathways through funding and adoption processes.

INTRODUCTION

This report outlines several specific case studies assessing the broader social and economic benefits of early investment into innovative pathology technologies or the impact of delayed investment.

Australia’s healthcare system, and healthcare systems worldwide, are facing challenges in meeting the needs of patients due to the ageing population and the increasing risks of chronic diseases, cancer, and emerging infections or pandemics. At the same time, governments have a responsibility to ensure that healthcare spending remains sustainable while providing equitable access to high-quality care. [8]

Longer, healthier lives can be achieved by preventing or slowing disease progression and facilitating recovery through prompt diagnosis and appropriate clinical management. Pathology technology assists by providing crucial diagnostic and prognostic information, enabling the selection of appropriate treatments, aiding in choosing preventative actions, and offering vital data to improve patient care. [9]

In Australia, over the past three decades, advancements in pathology technology have played a crucial role in driving ongoing enhancements in diagnostic service efficiency and overall healthcare outcomes [10]. During this period, diagnostic services have benefitted from these innovations – transforming laboratories from testing a few hundred patient samples a day to many thousands, reducing the time it takes to run a test, and taking the testing platforms out of the lab to bring them closer to the patient.

Pathology technology continues to experience remarkable advancements, with innovations emerging at an unparalleled rate. These advancements promise enhanced healthcare system efficiencies and positive patient outcomes. Yet these benefits will only be realised if the Australian healthcare system keeps pace with this innovation, acknowledges the value of such technology, and finds a way to deliver these advancements to all Australians equitably.

This report…

Seeks to uncover the unrealised value of pathology technology

This report will…

Showcase 8 pathology technologies and the broader social and economic impacts

The challenge for Australia, and all countries, lies in evaluating the affordability of pathology technology and determining how to gauge the value of these technological advancements. Health Technology Assessment (HTA) is the preferred tool for the Australian Government to assess the value of new technologies. In Australia, entities like the Medical Services Advisory Committee (MSAC) heavily depend on HTA, and MSAC plays a pivotal role in recommending which new medical technologies and services should receive funding for the Australian population. Nonetheless, both MSAC and other state funding organisations tend to have a limited focus, primarily emphasising traditional clinical and health economic aspects. The full range of potential benefits of diagnostic technology beyond these traditional measures – such as providing patients and their families with knowledge or hope – is often overlooked [8]. As a result, we overlook the broader economic value in terms of cost- containment as well as fostering improved health outcomes, ultimately leading to more efficient use of resources.

Australia has been slow to fund the adoption of innovative pathology technology, including genomic, point of care and digital health technologies. Barriers in the funding process delay the investment required for funded access, thus Australia misses out on direct savings to the healthcare system as well as the better patient outcomes, and broader social and economic benefits that pathology technology has to offer.

A paradigm shift is required for MSAC and other state funding bodies to realise the broader value of pathology technology and view it as an investment rather than a cost. We also need an accelerated pathway for funding and adoption of high-value
medical tests and technologies and those that address under-served needs.

BACKGROUND

WHAT IS PATHOLOGY TECHNOLOGY?

Pathology technology drives the provision of high-quality, accessible, and affordable healthcare services. It stands as a cornerstone in modern medicine, offering critical insights that influence patient care decisions every day. Over 70% of medical diagnoses and management decisions rely on pathology test results, including 100% of cancer diagnoses. Early disease detection using this technology aids healthcare provision by informing care decisions, leading to decreased healthcare costs [8].

Pathology technology is at the heart of Australia’s health care system.

It underpins every aspect of medicine, from diagnostic testing and monitoring of chronic diseases to cutting-edge genetic research and blood transfusion technologies.

Every advancement in this field improves our ability to detect diseases earlier, understand them better, and treat them more effectively. For instance, the rise of molecular diagnostics has revolutionised our approach to various cancers, allowing for targeted therapies tailored to individual genetic profiles. Moreover, in an era where infectious diseases can swiftly become global pandemics, rapid and accurate diagnostic tools in pathology become our first line of defence, guiding timely interventions. The true value of pathology technology, therefore, lies not just in its diagnostic precision but in its profound impact on enhancing patient outcomes, reducing resource use, and improving health inequalities.

The future of patient care relies on a healthcare system that is resilient for future populations – technology and patient, family and society outcomes are not separate entities, they are intricately connected components.

“Diagnostic services are vital for the prevention, diagnosis, case management, monitoring and treatment of communicable, noncommunicable, neglected tropical and rare diseases, injuries and disabilities” – WHO [5]

RELY ON PATHOLOGY FOR
DIAGNOSIS AND CARE MANAGEMENT

Of all medical diagnoses

0 %

Of all medical diagnoses

0 %

PATHOLOGY
APPLICATIONS

Predict

Predict susceptibility to disease

PREVENT

Prevent disease by identifying risk factors in patients that can be modified

DIAGNOSE

Diagnose many diseases. For cancer, every case is diagnosed by pathology

DETERMINE

Determine patient prognosis

IDENTIFY

Identify the presence or absence of infection

MONITOR

Monitor disease, identifying whether treatments work or should be adjusted or avoided

PERSONALISE

Personalise treatment to get the best result

INNOVATION IN PATHOLOGY

Innovation, derived from scientific development, is a core component of quality improvement in healthcare. While innovation in pathology technology is anticipated and appreciated in the field of medicine, it frequently goes unnoticed or remains unrecognised because of a fragmented funding process and a failure to acknowledge the potential value it could offer. Pathology technology is a rapidly evolving area, continuously offering faster, more informative results for patients who are provided access to these innovations. The progress made offers significant opportunity for new and upgraded approaches to individual and public health challenges in Australia.

Faster integration of these innovative technological advances creates a better, more robust healthcare system that optimises patient-centred care in every instance, regardless of geography, age and socioeconomic status.

Earlier in 2023, the World Health Organization (WHO) conducted a horizon scan to identify trends and emerging technologies in health which could be harnessed to improve the health of populations [11]. The report highlighted the importance of adopting a “future-thinking mindset” to ensure equitable and timely access to these new innovations and ranked these technologies into the overall top five most promising areas of innovation. Unsurprisingly, pathology technology featured – directly or indirectly – in all five areas. Timely investment in such technology is crucial for the Australian healthcare system, ensuring it remains adaptive, responsive, and equipped to provide world-class care.

TOP 5 AREAS OF
PROMISING INNOVATION

Genomics

Application of genomics for early diagnosis and pre-diagnosis of diseases to guide management and treatment.

Example: Whole genome sequencing to diagnose individuals with rare disease.

Vaccines

Better coordinated, more effective systems of vaccine production and global distribution.

Example: Genetic sequencing of the coronavirus to better understand its makeup and develop an mRNA vaccine [190]

Low-cost Viral Diagnosis

Rapidly design and construct cost-effective point-of-care diagnostics for viruses.

Example: POC test to diagnose Hepatitis C and provide a cure (see pg. 55) [14]

Antimicrobial Drugs

Broad-spectrum antimicrobial drugs that do not cause resistance or tolerance; e.g. adapt their conformation to structural changes or mutations in the target.

Example: Genetic sequencing of infectious organism that cause pneumonia to better understand their makeup and develop drugs which evade their processes or resistance [15]

Rapid Remote Diagnostics

Connect people through cell phones, watches and other devices that can provide information on key markers and link health information in real-time to clinicians, people and other (public) health entities, supporting individual health promotion, disease prevention and disease (self) management.
Example: Wearables which conduct ECGs that assist in the diagnosis of cardiovascular disease [16]

Making sure all Australians have access to the latest medicines and medical tests is an Albanese Government priority.

The Hon Mark Butler [1]

FUNDING INNOVATIVE PATHOLOGY TECHNOLOGY

Australia needs equitable and timely access for the full value of pathology technology to be realised. However, the key to access relies upon changes to our current policies, frameworks, and funding of innovative pathology technology.

Pathology relies on a mix of federal funding from the Medicare Benefits Scheme (MBS), state funding from public hospitals, and clinical trials. State Governments assign funds to Local Health Networks, which in turn distribute them to their respective hospitals. Typically, hospitals have a set budget designated for pathology. [17]

Laboratories typically charge hospitals for pathology tests on a fee-for-service basis. Federal Medicare funding is also fee-for- service according to the MBS item schedule fee. Despite the lower relative cost of testing compared to treatments, pathology has typically been underfunded compared to pharmaceuticals [17]. In addition, coupled with the underfunding of pathology, MBS funding is not directed to the technology supplier but to the laboratory that completes the test. The suppliers thus rely on a trickle down of reimbursement [18]. Technology that falls outside the use pattern of private or public laboratories (such as point of care (POC) testing, or at- home testing) also does not meet the current funding model criteria of ‘fee-for- service’.

FRAGMENTED FUNDING

Disconnect between state and federal funding of pathology technologies

Australia has a complex and fragmented healthcare system that splits and shares the funding and provision of services between the federal and state governments. The division or roles and responsibilities between levels of Government results in “cost and blame shifting” leading to gaps in services [19] and also budget silos that undermine efficiency [20].

The current financing structure reflects a complex and fragmented health care system that struggles to provide effective patient- centred care. Patients experience a lack of access to care, inequities of access depending on where they live, and delays in access, all of which could result in poorer health outcomes [20].

MSAC PATHWAY

MSAC pathways to reimbursement are long and complex

The MSAC process is often described as a rate- limiting step to accessing innovative technologies and subsequent treatment. The MSAC process, including the data generation and modelling requirements for HTA, is long and complex, which does not match the evolution of innovation and clinical practice. [21, 22]

Currently, the funding application process has many redundancies, requires local data generation, and can be a costly and time- consuming process, thus access to new and innovative technologies is slow. This is evidenced by the fact that Medicare’s coverage is limited compared to the number of tests available on the Australian Register of Therapeutic Goods (ARTG) in Australia. [17]

BROADER VALUE

Reimbursement or procurement decisions do not recognise the broader value of pathology technology

State procurement and HTA processes currently undervalue the broader benefits of pathology technology, particularly the value to other parts of the healthcare system.

In order to harness the innovation pipeline, the evaluation process needs to consider and reliably measure the many ways that pathology technology can create value beyond the traditional clinical and safety outcomes. This includes but is not limited to a broad array of patient-centric values such as increased knowledge and hope for a cure, as well as broader healthcare system values including resource optimisation and hospital savings. [17]

As Australia and the world continue to develop novel pathology technologies, we require flexibility and adaptability to ensure they are valued appropriately. At present, there is unrealised value in innovative pathology technology that Australia is failing to tap into.

THE UNREALISED VALUE OF PATHOLOGY TECHNOLOGY

As the pathology technology landscape is vast, dynamic, and continually evolving, the way we assess the funding of such technology must similarly adapt. Relying solely on traditional parameters of clinical and safety outcomes, limited only to immediate returns or a narrow scope of value, is inadequate. The broader value of such technology often lies beyond these primary outcomes, having deeper and sometimes intangible effects on society, including families, carers, employers, and various other sectors of state and federal Government.

To truly understand and appreciate the multifaceted value of pathology technology, funding assessments must consider both the indirect and direct impacts, taking into account the various stakeholders it can benefit. For instance, pathology technologies might not only diagnose diseases, but allow treatment to be identified, enhance workforce productivity, reduce immediate and long-term healthcare costs, and improve general wellbeing for both the patient, their families, and communities.

To demonstrate the elements of value, this report includes a Value Fountain, drawing on previous work [23], which highlights the numerous elements of value that may be overlooked or underappreciated in technology assessments. If Australia is to futureproof our healthcare system and continue to support the development of innovative pathology technologies, a paradigm shift in our perception of value is required.

Neglecting these broader benefits in a Health Technology Assessment (HTA), risks underestimating or undervaluing the transformative potential of innovative technologies, possibly stalling their future development, while denying access to patients. As such, a more holistic or ‘whole of Government’ approach to valuing technology is needed. It will ensure that we are not solely focussing on the health budget and limited definition of the value technology can provide, but that we leverage the expansive potential technology can bring to our society.

DISCOVER VALUES

THE VALUES

RESOURCE OPTIMISATION

Fast and accurate diagnoses, minimises the need for unnecessary tests, treatments, and hospital stays, facilitating the strategic use of resources.

Knowledge Dissemination

Results of a test can be used in research and for future generations of patients.

Community

Stopping the spread of disease creates a safe and vibrant society.

Efficency

Improved patient outcomes while reducing direct and indirect costs.

Personalisation

Using test results to tailor individualised treatment options, enhancing patient outcomes through personalised care.

Responsiveness

Rapid response to personal or public health crises and helps to control outbreaks, informs the need for vaccines and strengthens the health system.

Prevention

Early identification of at-risk patients improves patient outcomes and reduces cost.

Equity

Redistribution of health from equal access to essential services and resources.

LIFE

The intrinsic and inherent worth of every person

Hope

Benefits derived by a patient (or a patient’s family or carers) from knowing the results of a test that may provide a treatment or a cure in the future.

KNOWING

Harms avoided and benefits derived by a patient (or a patient’s family or carers) from knowing the results of a test or obtaining a diagnosis.

CURE

Elimination of a disease for individuals and the broader society.

THE VALUE FOUNTAIN

PATHOLOGY TECHNOLOGY -> DIRECT AND INDIRECT IMPACT -> VALUE

Diagnostics was the unsung hero in my story. It was testing that guided my diagnosis, my treatment and survival. Early Detection became my lifeline and without that, I wouldn’t be here and about to become a dad.

Hugo, colon and testicular cancer survivor

OVERVIEW
OF CASE STUDIES

The innovation provided by pathology technology can be transformative, and timely access to such technologies can bring a vast array of benefits to the Government, patients, families, and the community. Value that could have been provided by NT -proBNP and the PE ratio test are still yet to be realised. Value brought by the HRD test as well as the WES and rWGS was delayed by many years due to the long HTA process.

TOTAL VALUE FOREGONE

	PERSONALISATION	RESOURCE OPTIMISTION	KNOWING	HOPE	CURE	LIFE	RESPONSIVENESS	PREVENTION	KNOWLEDGE DISSEMINATION	EQUITY	COMMUNITY	EFFICIENCY
Heart Failure
Pre-Eclampsia
Ovarian Cancer
Genetic Conditions

TOTAL VALUE GAINED

	PERSONALISATION	RESOURCE OPTIMISTION	KNOWING	HOPE	CURE	LIFE	RESPONSIVENESS	PREVENTION	KNOWLEDGE DISSEMINATION	EQUITY	COMMUNITY	EFFICIENCY
COVID
Hepatitis C

TOTAL POTENTIAL VALUE

	PERSONALISATION	RESOURCE OPTIMISTION	KNOWING	HOPE	CURE	LIFE	RESPONSIVENESS	PREVENTION	KNOWLEDGE DISSEMINATION	EQUITY	COMMUNITY	EFFICIENCY
Blood Management
Bacterial/Viral Infections

CASE STUDIES

It [diagnostics] enabled access to a targeted treatment option to manage and prevent metastases of a rare cancer and without this targeted treatment, I simply wouldn’t be here. I hope that other patients are educated and empowered to pursue diagnostic testing interventions and hope that, with increased funding and support and improved access, that the right treatments are available, for the right patient, at the right time. After all, patients deserve hope, confidence and most importantly, a shot at life.

– Emily, NUT Carcinoma

REALISE THE VALUE OF PATHOLOGY TECHNOLOGY

To continue to realise the broad value of pathology technology including those tests highlighted in this report, Australia should adopt a model for pathology technology that changes our core perspective.

Contributing to a Wellness Economy

The overarching vision is a healthier Australia firmly based on a Wellness Economy. With this foundation, future policy and funding decisions move us incrementally but purposefully towards this outcome. This vision firmly supports and is a key contributor to the Treasurer’s Wellbeing Framework.

Establishment of Diagnostic Advisory Group

A multi-disciplinary advisory group that includes healthcare professionals and service providers, patient advocacy groups, industry bodies, and Government representatives. The group would advise on IVD-related health policy and funding, including the creation of a National Diagnostics Strategy and Roadmap, and adjudicate on high-medical value IVDs. They could also conduct periodic horizon scanning activities and potentially assist in identifying high-value Australian IVD innovations for accelerated local commercialisation initiatives to boost our sovereign capacity and support high-tech manufacturing. This group could also form the link between our major health strategies, such as the recently announced Australian Cancer Plan, and service providers, ensuring technology suppliers can develop and supply devices required to achieve our national healthcare goals.

Establishing a National Diagnostic Strategy and Roadmap

National leadership offers recognition for the critical role diagnostic tests and technology play in moving Australia to a wellness-based health economy. This position has many aspects, including the greater planned and funded use of diagnostic technologies such as genomics, proteomics, POC, and digital enablers (including AI). These technologies are advancing at speed, and current processes for funding and incorporation into routine healthcare are no longer fit for purpose. The rapidly changing nature of this sector demands a clear strategy and roadmap to ensure patient outcomes are improved and costs are reduced. These actions will set Australia on the road to a Wellbeing Economy. It also brings us into alignment with the WHA recommendation for countries to establish a diagnostics strategy.

Patient-Centred Strategic Elements to Support National Health Goals

Under the guidance of a Diagnostics Advisory Group, we could ensure our National Diagnostics Strategy and Roadmap (NDSR) had a strong patient-centric focus, encompassing the full Value Fountain as outlined in this report. Pathology technology is a keystone of our healthcare system – impacting almost every element of healthcare from diagnosis to prognosis. We must address the existing barriers to access if we are to secure the success of any other national healthcare priority. A brief overview of the priorities and key asks on the Department of Health and Aged Care demonstrate the clear need for a nationally coordinated approach that draws on the subject matter expertise of those currently supplying, delivering, and safeguarding our healthcare services.

Recent reports from Government, Patient Advocacy Groups, and Peak Bodies:

1 The Diagnostic Technology Sovereign Capability & Resilience National Action Plan identified the role of a NDSR as well as a legislated EAG to drive sustainable sovereign capability in key areas of the IVD sector.

2 The Intergenerational report acknowledges ““escalating health pressures, it will be important to ensure that the health system provides value for money. This requires a health system that innovates and prioritises funding a patient- centred and sustainable Australian healthcare system that delivers the best outcomes for communities This will require funding arrangements that continue to effectively invest in preventative health and evidence-based health care spending.”

3 The Department of Health and Aged Care Capability Review identified a critical challenge to “increasing focus on preventative healthcare”, the “need to address inequities between different population groups” and “the need to improve the sustainability of the health system”. That same report acknowledged the need for the Department to be “on the front foot in terms of opportunities in the rise of personalised medicine, mRNA technology, digital technologies, the promise of artificial intelligence and the revolution in genomics” – all of which can be served through a NDSR and Diagnostic Advisory Group.

4 Rare Cancer’s Rarefication: Personalised medicine in the genomic revolution calls to ”progress a coordinated national genomics strategy, as well as the need to adequately prioritise research into genomic studies and precision oncology”. The same report calls for “a new pathway in our Health Technology Assessments that encompasses broader value measures”.

5 CSIROs Strengthening Australia’s Pandemic Preparedness calls to “develop a diagnostics deployment strategy for scaling POC testing applications,” implement a diagnostics development program aimed at small and medium sized enterprises”, and to “Strengthen translational science to help bridge the gap between research, industry and the health system”.

6 ATSE Tech-Readiness Health Report highlighted technology as a solution to improve equity of access to healthcare and called on Government to support “investment in improving pathways to commercialisation for Australian-developed medical technology”.

7 Cancer Australia Australian Cancer Plan highlights the need for preventative and early detection measures that rely on a streamlined process of funding evolution in genetic tests and technology that underpin these goals.

It’s also vitally important that we make the best use of medicines and diagnostic technologies available to ensure better health outcomes for more Australians.

The Hon Mark Butler MP [7]

THE PATH
FORWARD

In today’s dynamic landscape of healthcare innovation, pathology technology stands as a beacon of promise, offering transformative potential for improving patient outcomes and advancing healthcare in Australia. It is a pivotal moment for the nation, where embracing this often under-valued facet of healthcare can take Australia from a nation primarily treating chronic diseases to a proactive healthcare society that pre-empts and manages illnesses before they take a firm grip. The discourse in this report presents an irrefutable case for the Australian federal Government to recognise the invaluable contribution of pathology technology and cultivate a comprehensive perspective.

Pathology technology cannot be confined as a budgetary line item in Australia’s healthcare system. When harnessed with a clear purpose, it forms an essential cornerstone of our healthcare infrastructure with broad-reaching effect. Its significance is being recognised globally; the World Health Organization acknowledges pathology technology as one of the five most promising areas of innovation, and the recent World Health Assembly (WHA) is urging Member States to elevate the role of diagnostics in their healthcare approach.

Timely investment in pathology technology provides gains in healthcare system efficiency, advances in disease prevention, and optimisation of responses and resource management. This value transcends obvious fiscal gains; benefiting the Government, patients, families, and society at large. Timely investments in this space go beyond the pioneering of healthcare solutions; it’s an opportunity to fortify Australia’s leadership position in an ever-evolving medical field.

Our current reimbursement pathways – complex and outmoded – struggle to keep pace with technological advancement. Fragmented funding structures, distributed across federal and state governments, foster inefficiency and impede the timely provision of innovative pathology technologies. Delayed access to these technologies has imposed a high cost that extends beyond dollars and cents. This report demonstrates over $7.0 billion has been forfeited due to delays in providing funded access to high-medical value technologies.

Consider, for instance, the delayed introduction of GP-requested NT-proBNP for suspected heart failure or the PE ratio test for pre-eclampsia. A staggering $5.9 billion could have been preserved by averting ED visits. Furthermore, timely access to the PE ratio test could have spared the Government another $235 million in reduced hospital admissions. Notably, the delay in providing access to WES/WGS meant that 1,068 additional children were left without a diagnosis, missing out on the vital support they and their families needed.

The Government’s potential benefits from acknowledging the value of pathology technology are substantial. Programs such as COVID-19 and HCV POC testing exemplify the immense benefits of early detection and patient-centred testing. These advantages translate to a substantial value of at least $1.8 billion, potentially saving countless lives. For instance, compared to conventional testing methods, the HCV program using POC testing saved an estimated 8 lives within a single year.

Embracing the broader spectrum of innovative pathology technology, including the Multiplex Assay for CNS infections and the POC coagulation test, could yield over $1.8 million in avoided hospital costs over the coming decade. Pathology technology holds the key to superior resource utilisation, heightened healthcare efficiency, and improved patient health outcomes. The development of the “Value Fountain” concept underscores the untapped potential that must be harnessed when considering investments in this field.

The recent Intergenerational Report underscores the mounting cost pressures on healthcare expenditure, driven by an ageing population, increased rates of chronic disease, and the escalating demand for high-quality healthcare services. This juncture represents an opportune moment for Australia to pioneer a nationally consistent framework for comprehensively assessing technology’s value in healthcare, including pathology technology.

Australia urgently requires a more comprehensive and inclusive approach that encapsulates the total value of pathology technology to patients, their families and to Government (both in terms of costs and lost productivity). In addition to HTA reform, the provision of an accelerated access program for high-medical value and promising innovative technologies is essential to curtail access delays.

A natural progression from this recognition is the development of an overarching Diagnostics Advisory Group to devise a pathology technology strategy for Australia – a NDSR. This comprehensive strategy should encompass a National Genomic Strategy (to replace the guidance that expired in 2021), digital health initiatives, including the strategic use of AI, POC testing, and a roadmap for innovative technology development, as recommended in the ADAPT Diagnostics Report [189].

As Australia stands at the threshold of transformative change in healthcare, pathology technology offers a wealth of opportunity. Through visionary leadership, innovative strategies, and judicious investments, we can unlock pathology technology’s full spectrum of value, securing a brighter and healthier future for Australia.

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ABBREVIATIONS

Artificial intelligence

ARTG

Australian Register of Therapeutic Goods

BNP

B-Type Natriuretic Peptide

CNS

Central nervous system

DAA

Direct-acting anti-virals

Emergency department

General practitioners

HCV

Hepatitis C

HRD

Homologous recombination deficiency

HTA

Health Technology Assessment

ICU

Intensive Care Unit

IVD

In Vitro Diagnostic

MBS

Medicare Benefits Scheme

MSAC

Medical Services Advisory Committee

NDSR

National Diagnostics Strategy and Roadmap

NHMRC

National Health and Medical Research Council

NSW

New South Wales

PBAC

Pharmaceutical Benefits Advisory Committee

PBM

Patient Blood Management

Pre-eclampsia

PMCC

Peter MacCallum Cancer Centre

POC

Point of care

TGA

Therapeutic Goods Administration

WES

Whole exome sequencing

WGS

Whole genome sequencing

WHA

World Health Assembly

WHO

World Health Organization