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Service Planning and New Health Intervention Assessment (SPNIA)

Work Programme


Information on topics processed through the SPNIA framework including business case documents.

Current topics - New Interventions / Technologies
TopicDescriptionLead organisationPriorityStatus as at 10 October 2008
Photodynamic TherapyFor the treatment of non-resectable cholangiocarcinoma.

Expected health gain would be the reduction in premature death, improved quality of life, and a reduction in QALY costs.		Auckland DHBHighNSTR has reviewed the business case and is considering further information on this topic before it finalises its recommendations.
Prophylactic Implantable Cardiac Defibrillator (ICD) ImplantationICDs are currently being implanted in patients by Auckland DHB Cardiology team. The issue is should ICDs be implanted for the primary prevention of sudden cardiac death in all patients who meet the NZ Pacing and Electrophysiology Group (NZPEG) criteria.

Expected health gain would be the reduction in premature death.		Canterbury DHBHighNSTR decided to approach the Northern Region to lead the writing of the business case.
Sprint Protocol for ICUsThis technology was the supreme winner of the New Zealand Health Innovation Awards in 2006. SPRINT is a glycaemic management device and protocol, developed by the University of Canterbury and Canterbury DHB for hospital intensive care units (ICUs). SPRINT allows clinicians and nurses to maintain ICU patients within a tight glycaemic range and avoid the clinical complications associated with hyperglycaemia.

SPRINT has been in use at Christchurch Hospital for 3 years and has shown significant clinical outcome improvements. The proposal would be to consider whether to further roll-out SPRINT across ICUs and evaluate the impact of SPRINT on ICU resources.		Ministry of HealthHighWork on developing a proposal for change not commenced.
Medical Silhouette Product for Wound Care Management This technology was the supreme winner of the New Zealand Health Innovation Awards in 2007. It is a computerised wound imaging, analysis and documentation system. Through the use of technology this solution captures images of the patient using a custom-designed camera, allows accurate quantitative information to be derived from those images, and builds that information into an electronic patient record for printing, electronic distribution, and archiving.

Expected gains would be around potential for improved patient care and potential for reducing costs.		Ministry of HealthHighWork on developing a proposal for change not commenced.
Virtual CT angiography (3D images rendering by CT scanning)Virtual CT angiography is an example of the ability to maximize current technology development for wider purposes. This procedure can enable an element of screening for heart disease that may mean a patient does not require a more invasive angiogram procedure. Ministry of HealthMediumNSTR agreed to have some follow up with the College of Radiologists.
Selective Fetoscopic Laser Photocoagulation (SFLP) – for the Treatment of Twin to Twin Transfusion Syndrome (TTTS)Twin pregnancies where the fetuses are sharing a placenta (monochorionic) are high risk. One of the main concerns is the development of TTTS. In this condition there is a high risk of perinatal morbidity and mortality, which may translate into long-term complications e.g. cerebral palsy. Over the last 15 years a new treatment has been developed, SFLP, which significantly reduces deaths, premature births and cerebral palsy rates. Only 20 cases need to be performed to avoid one case of cerebral palsy. This is now considered the gold standard across the world.

New Zealand women currently have the opportunity to go to Australia for SFLP, but currently it is estimated that only a quarter of those who are candidates are going. The proposal would involve the provision of SFLP in New Zealand at a national centre (Auckland DHB) rather than patients going to Australia. Expected gains would be to improve equity of access to SFLP and improve the clinical outcomes for patients. 		Auckland DHBMediumItem to be removed from the SPNIA work programme as Auckland DHB Clinical Practice Committee (CPC) considered a business case and supported its implementation. Funding for the service being provided through the Ministry of Health.

Planning for the service to be considered in conjunction with Ministry of Health as part of national paediatric service planning.
Virtual CT colonoscopy (3D images rendering by CT scanning)Virtual colonoscopy is an example of the ability to maximize current technology development for wider purposes. This procedure enables an element of screening for colorectal disease that may mean a patient does not require a more invasive colonoscopic or angiogram procedure. Ministry of HealthLow - unless wider applicability to potential screening programmeNSTR agreed to follow up with the College of Radiologists.
Magnetic Resonance SpectroscopyWhat are the differences in Magnetic Resonance Spectroscopy and PET/CT in the diagnosis of cancer e.g. efficiency, cost-effectiveness, accuracy, and the identification of tumour type?Ministry of Health - Horizon Scanning report is being done by HSACLowThe Ministry of Health has requested a report from the Health Services Assessment Collaboration (HSAC) on this topic.
Purcutaneous Aortic Valve This technology will allow patients to have valve replacements without the need for open-heart surgery. It will also enable valve replacement for patients who would not be able to have it with open-heart surgery.Waikato DHB-A proposal for change is being developed.


Current Topics - Service Planning / Reconfiguration
TopicDescriptionLead organisationPriorityStatus as at 10 October 2008
Drug-Eluting Stents (DES)DES are effective in reducing the development of restenosis, and hence the need to repeat angioplasty procedures. However up until recently they were significantly more costly compared with bare mental stents, hence each DHB funder has had a different view as to the level of funded intervention, if at all, and this has led to varying rates across New Zealand.

The intent would be to undertake an assessment of DES in order to ensure equitable access the country in the treatment of ischemic heart disease; to look to develop national consensus on an appropriate intervention rate and to explore a national procurement strategy for the purchase and supply of DES.		Counties Manakau DHBHighNSTR considered the proposal for change at its meeting on 10 October 2008 and recommended that the matter should proceed to a business case.

The Ministry of Health are in the process of looking to secure additional support for the development and writing of the business case.
a) Clinical Genetic Services

(b) A National Registry for Inherited Cardiac Diseases (screening for Long QT Syndrome).		There are a number of issues around the sustainability and quality of clinical genetics services in New Zealand. There has been work undertaken by the National Health Committee, Human Genome Research Project, Bioethics Council, plus internal work by DHBs and the Ministry of Health.

DHBs have completed some initial work through DHBNZ on what is required to sustain the service. This work proposed that a business case be developed to look at options to address the key risks and the process (including estimate of costs) to implement the preferred option(s) for the future shape of a genetic testing service across New Zealand.		(a) Ministry of Health

(b) Auckland DHB		High(a) NSTR considered the proposal for change at its meeting on 10 October 2008 and recommended that the matter should proceed to a business case.

(b) NSTR considered the proposal for change at its meeting on 10 October 2008 and recommended that the matter should proceed to a business case.

NSTR agreed that the business cases should be developed separately, but have strong overlap. NSTR recommended that business should be developed by one individual or team.

The Ministry of Health are in the process of looking to secure additional support for the development and writing of the business case.
Paediatric Specialist Services *Current service configuration for a number of paediatric sub-specialties is increasingly vulnerable. The proposal would look at how services are planned at the local, regional and national levels to put in place comprehensive plans to ensure future sustainable service provision.Ministry of HealthHigh *Discussions underway under the lead of the Long Term System Framework around national planning for paediatric services. Two areas being considered presently paediatric rheumotology and SFLP (refer to item 6).
Stroke ServicesThere is good evidence around the development and establishment of health / clinical network and how this can improve patient outcomes.

The proposal would be how to progress the development of such a health / clinical network for better coordinated and planned stroke services across DHBs.		Ministry of HealthHigh *Not required to go through a SPNIA process as Ministry of Health’s Quality Improvement Plan (QIP) for service for Diabetes and Cardiovascular Disease will address issues.

NSTR however is seeking an update in April 2009 on progress with QIP work programme.
Grommet surgery as treatment of Otitis Media with Effusion (OME)OME describes a continuum of conditions ranging from asymptomatic middle ear effusion to recurrent episodes of acute ototis media (AOM), and persistent middle ear effusion, all of which lead to chronic middle ear inflammation. It is a common condition in children under the age of 15 years. The major long-term consequences of OME are of two types – those related to potential hearing loss and those related to physical deterioration in the middle ear cavity.

There are many treatments proposed for OME. Surgery is still considered the definitive treatment for OME, and comprises the insertion of ventilation tubes (grommets), either alone or in combination with adenoidectomy. This intervention has been critically evaluated by a number of groups who found little evidence of long term benefit with respect to developmental outcomes, although there were definite, albeit short term improvements to hearing, as long as the tubes remained patent.

The proposal would be to review criteria used for public funding of grommet surgery to incorporate recent research and recommendations in this area. Recent guidelines have been produced by NICE on this area.		Ministry of HealthHighNICE published new guidelines for the use of grommets early in 2008.

NSTR agreed to discuss the topic with the Ministry’s Child, Youth and Maternity team to consider if and how to assess the current use of grommets in New Zealand.
National Electronic Health LibraryThe aim of the proposal would be to establish a single purchaser of electronic health information, with country wide coverage to peer reviewed information to all publicly funded health professionals. The provision of such information would inform health practitioner decision making and improve patient care. There are cost and health benefits to be gained from national coverage.Ministry of HealthHighWork on developing a proposal for change not commenced.
Map of MedicineThe Map of Medicine is a proprietary repository of clinical best practice to which any accredited clinician can have web access. The pedigree of the Map of Medicine appears good: the inputs are evidence based (Cochrane Collaboration; UK National Institute for Clinical Evidence), and the processes have the support of reputable organisations, notably the NHS in England and Wales. Other jurisdictions are in the process of deployment, notably Sweden and Queensland.

The proposition is for New Zealand to agree to a national license and deployment framework.

The Map of Medicine responds to a very clear need: providing clinicians with quick access to agreed authoritative clinical advice; providing planners with a basis on what to integrate and streamline service design. 		Wairarapa DHB (not agreed yet)MediumWork on developing a proposal for change not commenced.

* Subject to alignment with the Long Term System Framework work programme

Completed topics
TopicLead DHBStatus and business case documents
Positron Emission Tomography (PET) ScanningAucklandThe DHB CEOs have made their decision on the business case. NSTR’s role is now complete.

The business case, NSTR’s recommendations and the DHB CEOs’ decision are below:

The Ministry prepared a paper on the clinical indications for publically funded PET scanning. The CEOs support the case in principle but have asked for further details before they make a final decision.
Management of Morbid Obesity Counties-ManukauNSTR considered the case in May 2008 and its recommendations were sent to the Ministry’s Executive Leadership Team and the DHB CEOs. NSTR’s role is now complete.

NSTR’s recommendations were supported, in principle, by the Ministry’s Executive Leadership Team and by DHB CEOs.

The business case, NSTR’s recommendations, supporting documents, and the DHB CEOs’ feedback are below:

Deep Brain StimulationAucklandNSTR considered and supported the Proposal for Change, and agreed that it was sufficient to be treated as a business case.

NSTR finalised its recommendations in August 2008 and these have been sent to the Ministry’s Executive Leadership Team and to the DHB CEOs.

NSTR’s role is now complete.

The assessment of the business case is below:

Left Ventricular Assist Devices (LVADs)AucklandNSTR finalised its recommendations in August 2008 and these have been sent to the Ministry’s Executive Leadership Team and to the DHB CEOs.

NSTR’s role is now complete.

The assessment of the business case is below:


Archived topics
TopicNSTR discussionNext steps
AvastinNSTR agreed at its 11 May meeting to remove this topic from its ‘potential SPNIA proposals’ list as Avastin is already used or available in New Zealand.None required for NSTR.
Cemented compared to uncemented hip prosthesesNSTR agreed at its 11 May meeting to remove this topic from its ‘potential SPNIA proposals’ list as the proposal relates to a guideline change, which is outside NSTR’s scope.None required for NSTR.
Virtual colonoscopy (3D image rendering by Computed Tomography scanning)NSTR agreed at its 11 May meeting to remove this topic from its ‘potential SPNIA proposals’ list as the proposal relates to a relatively minor modification of an existing technology, e.g. CT angiography, and is already deployed in two DHBs.None required for NSTR.
Anti-D immunoglobin as routine prophylaxis in pregnancyThis proposal relates to a service delivery. NSTR did not consider service delivery proposals in its first year.

NSTR has advised the New Zealand Blood Service about the service delivery impacts.		NSTR to check with the New Zealand Blood Service that relevant action has been taken.
Non-contact cardiac mappingNSTR received comments on this topic from Auckland and Canterbury DHBs.NSTR received Auckland DHB’s evaluation of the service and decided not to take any further action on the service at this time.
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Page last updated: 11 November 2008


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