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Ming J, He Y, Yang Y, Hu M, Zhao X, Liu J, Xie Y, Wei Y, Chen Y. Health technology assessment of medical devices: current landscape, challenges, and a way forward. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:54. [PMID: 36199144 PMCID: PMC9533595 DOI: 10.1186/s12962-022-00389-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Health Technology Assessment (HTA) has been widely recognized as informing healthcare decision-making, and interest in HTA of medical devices has been steadily increasing. How does the assessment of medical devices differ from that of drug therapies, and what innovations can be adopted to overcome the inherent challenges in medical device HTA? Method HTA Accelerator Database was used to describe the landscape of HTA reports for medical devices from HTA bodies, and a literature search was conducted to understand the growth trend of relevant HTA publications in four case studies. Another literature review was conducted for a narrative synthesis of the characteristic differences and challenges of HTA in medical devices. We further conducted a focused Internet search of guidelines and a narrative review of methodologies specific to the HTA of medical devices. Main body The evidence of HTA reports and journal publications on medical devices around the world has been growing. The challenges in assessing medical devices include scarcity of well-designed randomized controlled trials, inconsistent real-world evidence data sources and methods, device-user interaction, short product lifecycles, inexplicit target population, and a lack of direct medical outcomes. Practical solutions in terms of methodological advancement of HTA for medical devices were also discussed in some HTA guidelines and literature. Conclusion To better conduct HTA on medical devices, we recommend considering multi-source evidence such as real-world evidence; standardizing HTA processes, methodologies, and criteria; and integrating HTA into decision-making. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-022-00389-6.
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Affiliation(s)
- Jian Ming
- Real World Solutions, IQVIA, Shanghai, 200124, China.,National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Yunzhen He
- Real World Solutions, IQVIA, Shanghai, 200124, China
| | - Yi Yang
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Min Hu
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Xinran Zhao
- Real World Solutions, IQVIA, Shanghai, 200124, China
| | - Jun Liu
- Real World Solutions, IQVIA, Shanghai, 200124, China
| | - Yang Xie
- Real World Solutions, IQVIA, Shanghai, 200124, China
| | - Yan Wei
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Yingyao Chen
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, 200032, China.
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Kovács S, Kaló Z, Daubner‐Bendes R, Kolasa K, Hren R, Tesar T, Reckers‐Droog V, Brouwer W, Federici C, Drummond M, Zemplényi AT. Implementation of coverage with evidence development schemes for medical devices: A decision tool for late technology adopter countries. HEALTH ECONOMICS 2022; 31 Suppl 1:195-206. [PMID: 35322478 PMCID: PMC9543994 DOI: 10.1002/hec.4504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
Experiences with coverage with evidence development (CED) schemes are fairly limited in Central and Eastern European (CEE) countries, which are usually late adopters of new health technologies. Our aim was to put forward recommendations on how CEE health technology assessment bodies and payer organizations can apply CED to reduce decision uncertainty on reimbursement of medical devices, with a particular focus on transferring the structure and data from CED schemes in early technology adopter countries in Western Europe. Structured interviews on the practices and feasibility of transferring CED schemes were conducted and subsequently, a draft tool for the systematic classification of decision alternatives and recommendations was developed. The decision tool was reviewed in a focus group discussion and validated within a wider group of CEE experts in a virtual workshop. Transferability assessment is needed in case of (1) joint implementation of a CED scheme; (2) transferring the structure of an existing CED scheme to a CEE country; (3) reimbursement decisions that are linked to outcomes of an ongoing CED scheme in another country and (4) real-world evidence transferred from completed CED schemes. Efficient use of available resources may be improved by adequately transferring evidence and policy tools from early technology adopter countries.
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Affiliation(s)
- Sandor Kovács
- Syreon Research InstituteBudapestHungary
- Center for Health Technology Assessment and Pharmacoeconomic ResearchFaculty of PharmacyUniversity of PécsPécsHungary
| | - Zoltán Kaló
- Syreon Research InstituteBudapestHungary
- Centre for Health Technology AssessmentSemmelweis UniversityBudapestHungary
| | | | - Katarzyna Kolasa
- Division of Health Economics and Healthcare ManagementKozminski UniversityWarsawPoland
| | - Rok Hren
- Institute of Mathematics, Physics, and MechanicsLjubljanaSlovenia
| | - Tomas Tesar
- Department of Organisation and Management of PharmacyFaculty of PharmacyComenius University in BratislavaBratislavaSlovakia
| | - Vivian Reckers‐Droog
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy and ManagementErasmus University RotterdamRotterdamThe Netherlands
- Erasmus School of EconomicsErasmus University RotterdamRotterdamThe Netherlands
| | - Carlo Federici
- Centre for Research on Health and Social Care Management (CERGAS)SDA Bocconi School of ManagementMilanItaly
- School of EngineeringWarwick UniversityCoventryUK
| | | | - Antal Tamás Zemplényi
- Syreon Research InstituteBudapestHungary
- Center for Health Technology Assessment and Pharmacoeconomic ResearchFaculty of PharmacyUniversity of PécsPécsHungary
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Kirwin E, Round J, Bond K, McCabe C. A Conceptual Framework for Life-Cycle Health Technology Assessment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1116-1123. [PMID: 35779939 DOI: 10.1016/j.jval.2021.11.1373] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Health technology assessment (HTA) uses evidence appraisal and synthesis with economic evaluation to inform adoption decisions. Standard HTA processes sometimes struggle to (1) support decisions that involve significant uncertainty and (2) encourage continued generation of and adaptation to new evidence. We propose the life-cycle (LC)-HTA framework, addressing these challenges by providing additional tools to decision makers and improving outcomes for all stakeholders. METHODS Under the LC-HTA framework, HTA processes align to LC management. LC-HTA introduces changes in HTA methods to minimize analytic time while optimizing decision certainty. Where decision uncertainty exists, we recommend risk-based pricing and research-oriented managed access (ROMA). Contractual procurement agreements define the terms of reassessment and provide additional decision options to HTA agencies. LC-HTA extends value-of-information methods to inform ROMA agreements, leveraging routine, administrative data, and registries to reduce uncertainty. RESULTS LC-HTA enables the adoption of high-value high-risk innovations while improving health system sustainability through risk-sharing and reducing uncertainty. Responsiveness to evolving evidence is improved through contractually embedded decision rules to simplify reassessment. ROMA allows conditional adoption to obtain additional information, with confidence that the net value of that adoption decision is positive. CONCLUSIONS The LC-HTA framework improves outcomes for patients, sponsors, and payers. Patients benefit through earlier access to new technologies. Payers increase the value of the technologies they invest in and gain mechanisms to review investments. Sponsors benefit through greater certainty in outcomes related to their investment, swifter access to markets, and greater opportunities to demonstrate value.
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Affiliation(s)
- Erin Kirwin
- Institute of Health Economics, Edmonton, AB, Canada; Health Organisation, Policy, and Economics, School of Health Sciences, University of Manchester, Manchester, England, UK.
| | - Jeff Round
- Institute of Health Economics, Edmonton, AB, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ken Bond
- Institute of Health Economics, Edmonton, AB, Canada
| | - Christopher McCabe
- Institute of Health Economics, Edmonton, AB, Canada; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Boriani G, Vitolo M, Svennberg E, Casado-Arroyo R, Merino JL, Leclercq C. Performance-based risk-sharing arrangements for devices and procedures in cardiac electrophysiology: an innovative perspective. Europace 2022; 24:1541-1547. [PMID: 35531864 DOI: 10.1093/europace/euac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/15/2022] [Indexed: 11/14/2022] Open
Abstract
There is an increasing pressure on demonstrating the value of medical interventions and medical technologies resulting in the proposal of new approaches for implementation in the daily practice of innovative treatments that might carry a substantial cost. While originally mainly adopted by pharmaceutical companies, in recent years medical technology companies have initiated novel value-based arrangements for using medical devices, in the form of 'outcomes-based contracts', 'performance-based contracts', or 'risk-sharing agreements'. These are all characterized by linking coverage, reimbursement, or payment for the innovative treatment to the attainment of pre-specified clinical outcomes. Risk-sharing agreements have been promoted also in the field of electrophysiology and offer the possibility to demonstrate the value of specific innovative technologies proposed in this rapidly advancing field, while relieving hospitals from taking on the whole financial risk themselves. Physicians deeply involved in the field of devices and technologies for arrhythmia management and invasive electrophysiology need to be prepared for involvement as stakeholders. This may imply engagement in the evaluation of risk-sharing agreements and specifically, in the process of assessment of technology performances or patient outcomes. Scientific Associations may have an important role in promoting the basis for value-based assessments, in promoting educational initiatives to help assess the determinants of the learning curve for innovative treatments, and in promoting large-scale registries for a precise assessment of patient outcomes and of specific technologies' performance.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,EHRA mHEALTH and Health Economics Section, European Heart Rhythm Association, Biot, France
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Emma Svennberg
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ruben Casado-Arroyo
- Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Josè L Merino
- Arrhythmia & Robotic EP Unit, University Hospital La Paz, Autonoma University, IdiPaz, Clinica Viamed-Santa Elena, Madrid, Spain
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Myung JE, Tanaka Y, Choi H, Strachan L, Watanuki T, Lee JH, Hwang H, Lee SS. Coverage with Evidence Development Programs for Medical Technologies in Asia-Pacific Regions: A Case Study of Japan and South Korea. JMA J 2021; 4:311-320. [PMID: 34796285 PMCID: PMC8580702 DOI: 10.31662/jmaj.2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
In this article, the operational characteristics of coverage with evidence development (CED) programs in Asia-Pacific regions, focusing on two countries―Japan and South Korea―are reviewed. Both countries recommended the introduction of CED to overcome the barrier of lack of robust clinical evidence in the early stages of the introduction of a medical technology. However, each country has a unique approach to CED implementation that reflects the differences in establishment and healthcare and policy environments. Japan adopted a “Challenge Application (CA)” program in 2018, and South Korea introduced the “Conditional Selective Benefit (CSB)” program in 2014. Despite the positive effects of CED programs, their governance and implementation should be improved to benefit patients in both countries from the improved access to new and innovative medical technologies. To this end, CED practices in the United States (the USA) can provide insights on how to improve CED operations in both countries.
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Affiliation(s)
- Jae-Eun Myung
- Healthcare Economics and Government Affairs, Medtronic Korea Ltd., Seoul, South Korea
| | - Yuji Tanaka
- Healthcare Economics and Government Affairs, Medtronic Japan Ltd., Tokyo, Japan
| | - Hyunsook Choi
- Healthcare Economics and Government Affairs, Medtronic Korea Ltd., Seoul, South Korea.,Department of Health Convergence, Ewha Womans University, Seoul, South Korea
| | - Liesl Strachan
- Global Health Policy, Medtronic Australasia Pty Ltd., Sydney, Australia
| | - Tomohiro Watanuki
- Healthcare Economics and Government Affairs, Medtronic Japan Ltd., Tokyo, Japan
| | - Ji-Hyun Lee
- Healthcare Economics and Government Affairs, Medtronic Korea Ltd., Seoul, South Korea
| | - Hyojung Hwang
- Healthcare Economics and Government Affairs, Medtronic Korea Ltd., Seoul, South Korea.,Department of Health Policy, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Sang-Soo Lee
- Healthcare Economics and Government Affairs, Medtronic Korea Ltd., Seoul, South Korea.,Graduate School for Medical Device Management and Research, SAIHST (Samsung Advanced Institute for Health Science & Technology), Sung Kyun Kwan University, Seoul, South Korea
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Distressed Communities Index in Patients Undergoing Transcatheter Aortic Valve Implantation in an Affluent County in New York. J Interv Cardiol 2021; 2021:8837644. [PMID: 34497479 PMCID: PMC8407997 DOI: 10.1155/2021/8837644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 07/07/2021] [Accepted: 08/13/2021] [Indexed: 12/30/2022] Open
Abstract
Background The clinical impact of the distressed communities index (DCI), a composite measure of economic well-being based on the U.S. zip code, is becoming increasingly recognized. Ranging from 0 (prosperous) to 100 (distressed), DCI's association with cardiovascular outcomes remains unknown. We aimed to study the association of the DCI with presentation and outcomes in adults with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve intervention (TAVR) in an affluent county in New York. Methods The study population included 286 patients with severe symptomatic AS or degeneration of a bioprosthetic valve who underwent TAVR with a newer generation transcatheter heart valve (THV) from December 2015 to June 2018 at an academic tertiary medical center. DCI for each patient was derived from their primary residence zip code. Patients were classified into DCI deciles and then categorized into 4 groups. The primary and secondary outcomes of interest were 30-day, 1-year, and 3-year mortality, respectively. Results Among 286 patients studied, 26%, 28%, 28%, and 18% were categorized into DCI groups 1–4, respectively (DCI <10: n = 73; DCI 10–20: n = 81; DCI 20–30: n = 80; DCI >30: n = 52). Patients in group 4 were younger with worse kidney function compared to patients in groups 1 and 2. They also had smaller aortic annuli and were more likely to receive a smaller THV. No significant difference in hospital length of stay or distribution of in-hospital, 30-day, 1-year, and 3-year mortality was demonstrated. Conclusions While the DCI was associated with differences in the clinical and anatomic profile, it was not associated with differences in clinical outcomes in this prospective observational study of adults undergoing TAVR suggesting that access to care is the likely discriminator.
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Muszbek N, Evans R, Remak E, Brennan VK, Colaone F, Shergill S, Ross P, Mullan D. Changes in treatment pattern and costs in advanced hepatocellular carcinoma (HCC). Expert Rev Pharmacoecon Outcomes Res 2021; 22:147-154. [PMID: 34488517 DOI: 10.1080/14737167.2021.1973892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION While essential for cost-effectiveness analyses, there are no current resource use and cost data available for advanced hepatocellular carcinoma (HCC) and selective internal radiation therapy (SIRT). The study aims to assess current resource use and costs in HCC and for SIRT compared to historical survey data. AREAS COVERED To address this data gap, resource use was elicited via surveys and interviews with medical professionals experienced with HCC and SIRT in the United Kingdom. Unit costs were from publicly available databases. Resource use and costs were estimated and compared to prior surveys. EXPERT OPINION From eleven responses, pre-progression costs for SIRT and systemic therapy were £256.77 and £292.27/month, respectively. One-off progression and post-progression costs were £209.98 and £522.84/month. Monthly costs were 54%-79% lower than in previous surveys, due to reduction in hospitalizations and funded social care. Furthermore, substantial differences in resource use associated with SIRT between clinical practice and clinical trials were found. In conclusion, increased availability and familiarity with systemic treatments has led to important changes in HCC care and SIRT administration. The uncertainty from the use of expert opinion and the limited number of hospitals with SIRT experience can be addressed with future research using large databases, registries.
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Affiliation(s)
| | | | | | - Victoria K Brennan
- Health Economics, Pricing, Reimbursement & Market Access, SIRTEX Medical United Kingdom Ltd, London, UK
| | - Fabien Colaone
- Health Economics, Pricing, Reimbursement & Market Access, SIRTEX Medical United Kingdom Ltd, London, UK
| | - Suki Shergill
- Health Economics, Pricing, Reimbursement & Market Access, SIRTEX Medical United Kingdom Ltd, London, UK
| | - Paul Ross
- Department of Medical Oncology, Guy's & St Thomas' Nhs Foundation Trust, London, UK
| | - Damian Mullan
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
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Sørensen SS, Storgaard LH, Weinreich UM. Cost-Effectiveness of Domiciliary High Flow Nasal Cannula Treatment in COPD Patients with Chronic Respiratory Failure. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:553-564. [PMID: 34168472 PMCID: PMC8219115 DOI: 10.2147/ceor.s312523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/13/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the cost-effectiveness of long-term domiciliary high flow nasal cannula (HFNC) treatment in COPD patients with chronic respiratory failure. PATIENTS AND METHODS A cohort of 200 COPD patients were equally randomized into usual care ± HFNC and followed for 12 months. The outcome of the analysis was the incremental cost per quality-adjusted life-year (QALY) gained, and the analysis was conducted from a healthcare sector perspective. Data on the patients' health-related quality of life (HRQoL), gathered throughout the trial using the St. George's Respiratory Questionnaire (SGRQ), was converted into EQ-5D-3L health state utility values. Costs were estimated using Danish registers and valued in British pounds (£) at price level 2019. Scenario analyses and probabilistic sensitivity analyses were conducted to assess the uncertainty of the results. RESULTS The adjusted mean difference in QALYs between the HFNC group and the control group was 0.059 (95% CI: 0.017; 0.101), and the adjusted mean difference in total costs was £212 (95% CI: -1572; 1995). The analysis resulted in an incremental cost-effectiveness ratio (ICER) of £3605 per QALY gained. At threshold values of £20.000-30.000 per QALY gained, the intervention had an 83-92% probability of being cost-effective. The scenario analyses all revealed ICERs below the set threshold value and demonstrated the robustness of the main result. CONCLUSION This is the first cost-effectiveness study on domiciliary HFNC in Europe. The findings demonstrate that long-term domiciliary HFNC treatment is very likely to be a cost-effective addition to usual care for COPD patients with chronic respiratory failure. The results must be interpreted in light of the uncertainty associated with the indirect estimation of health state utilities.
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Affiliation(s)
- Sabrina Storgaard Sørensen
- Danish Center for Health Care Improvements, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Line Hust Storgaard
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Enzing JJ, Vijgen S, Knies S, Boer B, Brouwer WB. Do economic evaluations of TAVI deal with learning effects, innovation, and context dependency? A review. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Daubner-Bendes R, Kovács S, Niewada M, Huic M, Drummond M, Ciani O, Blankart CR, Mandrik O, Torbica A, Yfantopoulos J, Petrova G, Holownia-Voloskova M, Taylor RS, Al M, Piniazhko O, Lorenzovici L, Tarricone R, Zemplényi A, Kaló Z. Quo Vadis HTA for Medical Devices in Central and Eastern Europe? Recommendations to Address Methodological Challenges. Front Public Health 2021; 8:612410. [PMID: 33490024 PMCID: PMC7820783 DOI: 10.3389/fpubh.2020.612410] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/07/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives: Methodological challenges in the evaluation of medical devices (MDs) may be different for early and late technology adopter countries, as well as the potential health technology assessment (HTA) solutions to tackle them. This study aims to provide guidance to Central and Eastern European (CEE) countries on how to address key challenges of HTA for MDs with special focus on the transferability of scientific evidence. Methods: As part of the COMED Horizon 2020 project, a comprehensive list of issues related to MD HTA were identified based on a targeted literature review. Health technology assessment issues which pose a greater challenge or require different solutions in late technology adopter countries were selected. Draught recommendations to address these issues were developed and discussed in a focus group. The recommendations were then validated with a wider group of experts, including HTA and reimbursement decision makers from CEE countries in May and June 2020. Results: A consolidated list of 11 recommendations were developed in 3 major areas: (1) clinical value assessment, focusing on the use of joint EU work, relying on real-world evidence, use of coverage with evidence development schemes, transferring evidence from foreign countries and addressing the challenges of learning curve and centre effect; (2) economic value assessment, covering cost calculation of complex medical devices and transferability of economic evaluations of MDs; (3) HTA processes, related to the frequent product modifications and various indications of MDs. Conclusions: Central and Eastern European countries with limited resources for conducting HTA, can benefit from HTA methods and evidence generated in early technology adopter countries. Considering the appropriate reuse of international HTA materials, late technology adopter countries can still implement HTA, even for MDs, which have a more limited evidence base compared with pharmaceuticals.
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Affiliation(s)
| | - Sándor Kovács
- Syreon Research Institute, Budapest, Hungary.,Centre for Health Technology Assessment, University of Pécs, Pécs, Hungary
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | | | - Michael Drummond
- Centre for Health Economics, University of York, York, United Kingdom
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy.,Evidence Synthesis and Modelling for Health Improvement, College of Medicine and Health, Institute of Health Research, University of Exeter, Exeter, United Kingdom
| | - Carl Rudolf Blankart
- KPM Center for Public Management, University of Bern, Bern, Switzerland.,sitem-insel AG, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Olena Mandrik
- School of Health and Related Research, Health Economics and Decision Science, The University of Sheffield, Sheffield, United Kingdom
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy.,Department of Social and Political Science, Bocconi University, Milan, Italy
| | - John Yfantopoulos
- School of Economics and Political Science, University of Athens, Athens, Greece
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Malwina Holownia-Voloskova
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.,Health Technology Assessment Department, State Budgetary Institution "Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department", Moscow, Russia
| | - Rod S Taylor
- Evidence Synthesis and Modelling for Health Improvement, College of Medicine and Health, Institute of Health Research, University of Exeter, Exeter, United Kingdom.,MRC/CSO Social and Public Health Sciences Unit and Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, United Kingdom
| | - Maiwenn Al
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Oresta Piniazhko
- HTA Department of State Expert Centre of Ministry of Health of Ukraine, Kyiv, Ukraine
| | - László Lorenzovici
- G. E. Palade University of Medicine, Pharmacy, Science and Technology, Tirgu Mures, Romania.,Syreon Research Romania, Tirgu Mures, Romania
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy.,Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Antal Zemplényi
- Syreon Research Institute, Budapest, Hungary.,Division of Pharmacoeconomics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.,Centre for Health Technology Assessment, Semmelweis University, Budapest, Hungary
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Wenzl M, Mossialos E. Prices For Cardiac Implant Devices May Be Up To Six Times Higher In The US Than In Some European Countries. Health Aff (Millwood) 2018; 37:1570-1577. [DOI: 10.1377/hlthaff.2017.1367] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Martin Wenzl
- Martin Wenzl is a research officer at the London School of Economics and Political Science, in England
| | - Elias Mossialos
- Elias Mossialos is a professor of health policy and management at the Institute of Global Health Innovation, Imperial College London, and the Brian Abel-Smith Professor of Health Policy at the London School of Economics and Political Science
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HEALTH TECHNOLOGY ASSESSMENT METHODS GUIDELINES FOR MEDICAL DEVICES: HOW CAN WE ADDRESS THE GAPS? THE INTERNATIONAL FEDERATION OF MEDICAL AND BIOLOGICAL ENGINEERING PERSPECTIVE. Int J Technol Assess Health Care 2018; 34:276-289. [DOI: 10.1017/s0266462318000314] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives:Current health technology assessment (HTA) methods guidelines for medical devices may benefit from contributions by biomedical and clinical engineers. Our study aims to: (i) review and identify gaps in the current HTA guidelines on medical devices, (ii) propose recommendations to optimize the impact of HTA for medical devices, and (iii) reach a consensus among biomedical engineers on these recommendations.Methods:A gray literature search of HTA agency Web sites for assessment methods guidelines on devices was conducted. The International Federation of Medical and Biological Engineers (IFMBE) then convened a structured focus group, with experts from different fields, to identify potential gaps in the current HTA guidelines, and to develop recommendations to fill these perceived gaps. The thirty recommendations generated from the focus group were circulated in a Delphi survey to eighty-five biomedical and clinical engineers.Results:Thirty-two panelists, from seventeen countries, participated in the Delphi survey. The responses showed a strong agreement on twenty-seven of thirty recommendations. Some uncertainties remain about the methods to accurately assess the effectiveness and safety, and interoperability of a medical device with other devices or within the clinical setting.Conclusions:As medical devices differ from drug therapies, current HTA methods may not accurately reflect the conclusions of their assessment. Recommendations informed by the focus group discussions and Delphi survey responses aimed to address the perceived gaps, and to provide a more integrated approach in medical device assessments in combining engineering with other perspectives, such as clinical, economic, patient, human factors, ethical, and environmental.
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Ghabri S, Cleemput I, Josselin JM. Towards a New Framework for Addressing Structural Uncertainty in Health Technology Assessment Guidelines. PHARMACOECONOMICS 2018; 36:127-130. [PMID: 29264865 DOI: 10.1007/s40273-017-0603-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Salah Ghabri
- Department of Economic and Public Health Evaluation, French National Authority for Health (HAS), 5 Avenue du Stade de France, 93218, Saint-Denis La Plaine cedex, France.
| | - Irina Cleemput
- Belgian Health Care Knowledge Centre (KCE), Boulevard du Jardin Botanique 55, 1000, Brussels, Brussels, Belgium
| | - Jean-Michel Josselin
- Faculty of Economics, University of Rennes 1, CREM-CNRS, 35065, Rennes cedex, Rennes, France
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Schnell-Inderst P, Hunger T, Conrads-Frank A, Arvandi M, Siebert U. Ten recommendations for assessing the comparative effectiveness of therapeutic medical devices: a targeted review and adaptation. J Clin Epidemiol 2018; 94:97-113. [DOI: 10.1016/j.jclinepi.2017.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/17/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
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Cowles E, Marsden G, Cole A, Devlin N. A Review of NICE Methods and Processes Across Health Technology Assessment Programmes: Why the Differences and What is the Impact? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:469-477. [PMID: 28130691 DOI: 10.1007/s40258-017-0309-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Decisions made by the National Institute for Health and Care Excellence (NICE) exert an influence on the allocation of resources within 'fixed' National Health Service budgets. Yet guidance for different types of health interventions is handled via different 'programmes' within NICE, which follow different methods and processes. OBJECTIVE The objective of this research was to identify differences in the processes and methods of NICE health technology assessment programmes and to explore how these could impact on allocative efficiency within the National Health Service. METHODS Data were extracted from the NICE technology appraisal programme, medical technologies guidance, diagnostic assessment programme, highly specialised technologies programme, and clinical guidelines process and methods manuals to undertake a systematic comparison. Five qualitative interviews were carried out with NICE members of staff and committee members to explore the reasons for the differences found. RESULTS The main differences identified were in the required evidence review period, or lack thereof, mandatory funding status, the provision of a reference case for economic evaluation, the requirement for and the type of economic analysis undertaken, and the decision making criteria used for appraisal. CONCLUSION Many of the differences found can be justified on grounds of practicality and relevance to the health technologies under assessment. Nevertheless, from a strict utilitarian view, there are several potential areas of inefficiency that could lead to the misallocation of resources within the National Health Service, although some of these might be eliminated or reduced if an egalitarian view is taken. The challenge is determining where society is willing to trade health gains between different people.
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Affiliation(s)
- Emma Cowles
- Office of Health Economics, 7th floor, 105 Victoria Street, London, SW1E 6QT, UK.
| | - Grace Marsden
- Office of Health Economics, 7th floor, 105 Victoria Street, London, SW1E 6QT, UK
| | - Amanda Cole
- Office of Health Economics, 7th floor, 105 Victoria Street, London, SW1E 6QT, UK
| | - Nancy Devlin
- Office of Health Economics, 7th floor, 105 Victoria Street, London, SW1E 6QT, UK
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Motte AF, Diallo S, van den Brink H, Châteauvieux C, Serrano C, Naud C, Steelandt J, Alsac JM, Aubry P, Cour F, Pellerin O, Pineau J, Prognon P, Borget I, Bonan B, Martelli N. Existing reporting guidelines for clinical trials are not completely relevant for implantable medical devices: a systematic review. J Clin Epidemiol 2017; 91:111-120. [PMID: 28728922 DOI: 10.1016/j.jclinepi.2017.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 06/27/2017] [Accepted: 07/12/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to determine relevant items for reporting clinical trials on implantable medical devices (IMDs) and to identify reporting guidelines which include these items. STUDY DESIGN AND SETTING A panel of experts identified the most relevant items for evaluating IMDs from an initial list based on reference papers. We then conducted a systematic review of articles indexed in MEDLINE. We retrieved reporting guidelines from the EQUATOR network's library for health research reporting. Finally, we screened these reporting guidelines to find those using our set of reporting items. RESULTS Seven relevant reporting items were selected that related to four topics: randomization, learning curve, surgical setting, and device information. A total of 348 reporting guidelines were identified, among which 26 met our inclusion criteria. However, none of the 26 reporting guidelines presented all seven items together. The most frequently reported item was timing of randomization (65%). On the contrary, device information and learning curve effects were poorly specified. CONCLUSION To our knowledge, this study is the first to identify specific items related to IMDs in reporting guidelines for clinical trials. We have shown that no existing reporting guideline is totally suitable for these devices.
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Affiliation(s)
- Anne-France Motte
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015 Paris, France
| | - Stéphanie Diallo
- Pharmacy Department, Foch Hospital, 40 rue Worth, 92151 Suresnes, France
| | - Hélène van den Brink
- Université Paris-Sud, Université Paris-Saclay, EA7358 GRADES, 5 rue Jean-Baptiste Clément, 92290 Châtenay-Malabry, France
| | - Constance Châteauvieux
- Pharmacy Department, Saint Antoine Hospital, AP-HP, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Carole Serrano
- Pharmacy Department, Ambroise Paré Hospital, AP-HP, 9 Avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Carole Naud
- General Agency of Equipment and Health Products, AP-HP, 7 rue du Fer à Moulin, 75005 Paris, France
| | - Julie Steelandt
- General Agency of Equipment and Health Products, AP-HP, 7 rue du Fer à Moulin, 75005 Paris, France
| | - Jean-Marc Alsac
- Department of Cardiac and Vascular Surgery, INSERM U970 Faculté de Médecine René Descartes, Paris 5. Georges Pompidou European Hospital, AP-HP, 20-56 rue Leblanc, 75015 Paris, France
| | - Pierre Aubry
- Department of Cardiology, Gonesse Hospital, 2 boulevard du 19 mars 1962, 95500 Gonesse, France
| | - Florence Cour
- Department of Urology, Foch Hospital, 40 rue Worth, 92151 Suresnes, France
| | - Olivier Pellerin
- Interventional Radiology Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015, Paris, France; INSERM U970, Université Paris Descartes-Sorbonne-Paris Cité Faculté de médecine, 56, rue Leblanc, 75015, Paris, France
| | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015 Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015 Paris, France
| | - Isabelle Borget
- Université Paris-Sud, Université Paris-Saclay, EA7358 GRADES, 5 rue Jean-Baptiste Clément, 92290 Châtenay-Malabry, France; Department of Health Economics, Gustave Roussy Institute, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Brigitte Bonan
- Pharmacy Department, Foch Hospital, 40 rue Worth, 92151 Suresnes, France
| | - Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 rue Leblanc, 75015 Paris, France; Université Paris-Sud, Université Paris-Saclay, EA7358 GRADES, 5 rue Jean-Baptiste Clément, 92290 Châtenay-Malabry, France.
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Hatz MHM, Schreyögg J, Torbica A, Boriani G, Blankart CRB. Adoption Decisions for Medical Devices in the Field of Cardiology: Results from a European Survey. HEALTH ECONOMICS 2017; 26 Suppl 1:124-144. [PMID: 28139093 DOI: 10.1002/hec.3472] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/29/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Abstract
Decisions to adopt medical devices at the hospital level have consequences for health technology assessment (HTA) on system level and are therefore important to decision makers. Our aim was to investigate the characteristics of organizations and individuals that are more inclined to adopt and utilize cardiovascular devices based on a comprehensive analysis of environmental, organizational, individual, and technological factors and to identify corresponding implications for HTA. Seven random intercept hurdle models were estimated using the data obtained from 1249 surveys completed by members of the European Society of Cardiology. The major findings were that better manufacturer support increased the adoption probability of 'new' devices (i.e. in terms of CE mark approval dates), and that budget pressure increased the adoption probability of 'old' devices. Based on our findings, we suggest investigating the role of manufacturer support in more detail to identify diffusion patterns relevant to HTA on system level, to verify whether it functions as a substitute for medical evidence of new devices, and to receive new insights about its relationship with clinical effectiveness and cost-effectiveness. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Jonas Schreyögg
- Hamburg Center for Health Economics, University of Hamburg, Germany
| | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Department, University of Modena and Reggio Emilia, Modena University Hospital, Modena, Italy
- European Society of Cardiology, Sophia Antipolis, France
| | - Carl R B Blankart
- Hamburg Center for Health Economics, University of Hamburg, Germany
- Center for Gerontology and Health Care Research, School of Public Health, Brown University, Providence, RI, USA
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Rothery C, Claxton K, Palmer S, Epstein D, Tarricone R, Sculpher M. Characterising Uncertainty in the Assessment of Medical Devices and Determining Future Research Needs. HEALTH ECONOMICS 2017; 26 Suppl 1:109-123. [PMID: 28139090 DOI: 10.1002/hec.3467] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/18/2016] [Accepted: 11/23/2016] [Indexed: 05/24/2023]
Abstract
Decisions about the adoption of medical interventions are informed by evidence on their costs and effects. For a range of reasons, evidence relating to medical devices may be limited. The decision to adopt a device early in its life cycle when the evidence base is least mature may impact on the prospects of acquiring further evidence to reduce uncertainties. Equally, rejecting a device will result in no uptake in practice and hence no chance to learn about performance. Decision options such as 'only in research' or 'approval with research' can overcome these issues by allowing patients early access to promising new technologies while limiting the risks associated with making incorrect decisions until more evidence or learning is established. In this paper, we set out the issues relating to uncertainty and the value of research specific to devices: learning curve effects, incremental device innovation, investment and irrecoverable costs, and dynamic pricing. We show the circumstances under which an only in research or approval with research scheme may be an appropriate policy choice. We also consider how the value of additional research might be shared between the manufacturer and health sector to help inform who might reasonably be expected to conduct the research needed. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Claire Rothery
- Centre for Health Economics, University of York, York, UK
| | - Karl Claxton
- Centre for Health Economics, University of York, York, UK
- Department of Economics and Related Studies, University of York, York, UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York, UK
| | - David Epstein
- Department of Applied Economics, University of Granada, Granada, Spain
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
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Tarricone R, Torbica A, Drummond M. Challenges in the Assessment of Medical Devices: The MedtecHTA Project. HEALTH ECONOMICS 2017; 26 Suppl 1:5-12. [PMID: 28139084 DOI: 10.1002/hec.3469] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/23/2016] [Accepted: 11/23/2016] [Indexed: 05/12/2023]
Abstract
Assessing medical devices (MDs) raises challenges which require us to reflect on whether current methods are adequate. Major features of devices are: (i) device-operator interaction can generate learning curve effects; (ii) incremental nature of innovation needs to be addressed by careful identification of the alternatives for comparative and incremental cost-effectiveness analysis; and (iii) broader organizational impact in terms of training and infrastructure, coupled with dynamic pricing, requires a more flexible approach to costing. The objective of the MedtecHTA project was to investigate improvements in HTA methods to allow for more comprehensive evaluation of MDs. It consisted of several work packages concerning (i) the available evidence on the currently adopted approaches for regulation and HTA of medical devices; (ii) the geographical variation in access to MDs; (iii) the development of methodological frameworks for conducting comparative effectiveness research and economic evaluation of MDs; and (iv) the organizational impact of MDs. This introductory paper summarizes the main results of the project and draws out the main overarching themes. This supplement represents a comprehensive report of all the main findings of the MedtecHTA project, and it is intended to be the main source for researchers and policy makers wanting information on the project. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Rosanna Tarricone
- Cergas, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Aleksandra Torbica
- Cergas, Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Michael Drummond
- Cergas, Bocconi University, Milan, Italy
- Centre for Health Economics, University of York, York, UK
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Wilkinson G, Drummond M. Alternative approaches for assessing the socioeconomic benefits of medical devices: a systematic review. Expert Rev Med Devices 2016; 12:629-48. [PMID: 26305841 DOI: 10.1586/17434440.2015.1080118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many medical devices offer improvements over current care that may be difficult to assess using standard methods of economic benefit measurement such as the quality-adjusted life-year (QALY). The objective of this research was to explore the extent to which these benefits have been measured and valued by alternative approaches, such as willingness-to-pay studies or discrete choice experiments. We undertook a systematic review of the literature from 1996 to 2013 to identify empirical studies on the benefits of medical devices using the alternative methodologies. The search resulted in 2772 hits, of which 2016 were considered not relevant to the study and 76 were duplicates. After further examination, there were 30 relevant empirical studies, of which 18 were willingness-to-pay and 12 discrete choice experiments. This research demonstrates that while it is feasible to measure and value the attributes of devices using alternative approaches to standard quality-of-life measures, the literature is quite limited when compared with that for non-device technologies.
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Zhang R, Modaresi F, Borisenko O. Health economic evaluations of medical devices in the People's Republic of China: A systematic literature review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2015; 7:195-204. [PMID: 25914551 PMCID: PMC4399785 DOI: 10.2147/ceor.s78752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The objective of this study is to identify and review the methodological quality of health economic evaluations of medical devices performed in the People’s Republic of China. To our knowledge, no such investigations have been performed to date. Methods A systematic literature review involving searches of Medline, Medline In-Process, the National Health Service Economic Evaluation Database, the Cost-Effectiveness Analysis Registry of the Tufts Medical Center, and the Wanfang Database was performed. The search spanned the period from 1990 to 2013. Studies on health economic evaluations of medical devices, in-vitro diagnostics, procedures, and the use of medical devices in Chinese health care settings were included. Full-text articles and conference abstracts in English and Chinese were included. Results Fifty-seven publications were included, 26 (46%) of which were in English and 31 (54%) of which were in Chinese. The included publications covered a wide range of clinical areas, such as surgery (n=23, 40%), screening (n=9, 16%), imaging use (n=6, 11%), kidney intervention (n=4, 7%), and nine other technological areas. Most of the studies (n=31, 54%) were cost analyses. Among the others, 13 (50%) studies used modeling, and another 13 (50%) were within-trial evaluations. Among studies that used modeling, eleven (85%) conducted sensitivity analyses, six of which had one-way sensitivity analysis, whereas one conducted both one-way and two-way sensitivity analyses; four of these eleven modeling-based analyses included probabilistic sensitivity analyses. The incremental cost-effectiveness ratio was reported in ten (18%) studies, eight of which were screening studies. The remaining two modeling studies were in areas of imaging and oncology. Conclusion This study indicates that there are major limitations and deficiencies in the health economic evaluations on medical devices performed in the People’s Republic of China. Further efforts are required from different stakeholders – academic, governmental, and privatized – to improve health economic research capacity and to put it to use when informative decisions are made in the health care setting.
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Abstract
BACKGROUND In recent years, there has been growing interest in evaluating the health and economic impact of medical devices. Payers increasingly rely on cost-effectiveness analyses in making their coverage decisions, and are adopting value-based purchasing initiatives. These analytic approaches, however, have been shaped heavily by their use in the pharmaceutical realm, and are ill-adapted to the medical device context. METHODS This study focuses on the development and evaluation of left ventricular assist devices (LVADs) to highlight the unique challenges involved in the design and conduct of device trials compared with pharmaceuticals. RESULTS Devices are moving targets characterized by a much higher degree of post-introduction innovation and "learning by using" than pharmaceuticals. The cost effectiveness ratio of left ventricular assist devices for destination therapy, for example, decreased from around $600,000 per life year saved based on results from the pivotal trial to around $100,000 within a relatively short time period. CONCLUSIONS These dynamics pose fundamental challenges to the evaluation enterprise as well as the policy-making world, which this paper addresses.
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Craig JA, Carr L, Hutton J, Glanville J, Iglesias CP, Sims AJ. A review of the economic tools for assessing new medical devices. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:15-27. [PMID: 25139635 DOI: 10.1007/s40258-014-0123-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Whereas the economic evaluation of pharmaceuticals is an established practice within international health technology assessment (HTA) and is often produced with the support of comprehensive methodological guidance, the equivalent procedure for medical devices is less developed. Medical devices, including diagnostic products, are a rapidly growing market in healthcare, with over 10,000 medical technology patent applications filed in Europe in 2012-nearly double the number filed for pharmaceuticals. This increase in the market place, in combination with the limited, or constricting, budgets that healthcare decision makers face, has led to a greater level of examination with respect to the economic evaluation of medical devices. However, methodological questions that arise due to the unique characteristics of medical devices have yet to be addressed fully. This review of journal publications and HTA guidance identified these characteristics and the challenges they may subsequently pose from an economic evaluation perspective. These unique features of devices can be grouped into four categories: (1) data quality issues; (2) learning curve; (3) measuring long-term outcomes from diagnostic devices; and (4) wider impact from organisational change. We review the current evaluation toolbox available to researchers and explore potential future approaches to improve the economic evaluation of medical devices.
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Affiliation(s)
- Joyce A Craig
- York Health Economics Consortium, University of York, Level 2 Market Square, Vanbrugh Way, Heslington, York, YO10 5NH, UK,
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The view of European experts regarding health economics for medical nutrition in disease-related malnutrition. Eur J Clin Nutr 2015; 69:539-45. [DOI: 10.1038/ejcn.2014.280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 11/04/2014] [Accepted: 11/30/2014] [Indexed: 12/31/2022]
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ARE POLICY DECISIONS ON SURGICAL PROCEDURES INFORMED BY ROBUST ECONOMIC EVIDENCE? A SYSTEMATIC REVIEW. Int J Technol Assess Health Care 2014; 30:381-93. [DOI: 10.1017/s0266462314000531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives: The aim of this study was to examine the empirical and methodological cost-effectiveness evidence of surgical interventions for breast, colorectal, or prostate cancer.Methods: A systematic search of seven databases including MEDLINE, EMBASE, and NHSEED, research registers, the NICE Web site and conference proceedings was conducted in April 2012. Study quality was assessed in terms of meeting essential, preferred and UK NICE specific requirements for economic evaluations.Results: The seventeen (breast = 3, colorectal = 7, prostate = 7) included studies covered a broad range of settings (nine European; eight non-European) and six were published over 10 years ago. The populations, interventions and comparators were generally well defined. Very few studies were informed by literature reviews and few used synthesized clinical evidence. Although the interventions had potential differential effects on recurrence and mortality rates, some studies used relatively short time horizons. Univariate sensitivity analyses were reported in all studies but less than a third characterized all uncertainty with a probabilistic sensitivity analysis. Although a third of studies incorporated patients’ health-related quality of life data, only four studies used social tariff values.Conclusions: There is a dearth of recent robust evidence describing the cost-effectiveness of surgical interventions in the management of breast, colorectal and prostate cancers. Many of the recent publications did not satisfy essential methodological requirements such as using clinical evidence informed by a systematic review and synthesis. Given the ratio of potential benefit and harms associated with cancer surgery and the volume of resources consumed by these, there is an urgent need to increase economic evaluations of these technologies.
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The role of hospital payments in the adoption of new medical technologies: an international survey of current practice. HEALTH ECONOMICS POLICY AND LAW 2014; 10:133-59. [DOI: 10.1017/s1744133114000358] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThis study examined the role of prospective payment systems in the adoption of new medical technologies across different countries. A literature review was conducted to provide background for the study and guide development of a survey instrument. The survey was disseminated to hospital payment systems experts in 15 jurisdictions. Fifty-one surveys were disseminated, with 34 returned. The surveys returned covered 14 of the 15 jurisdictions invited to participate. The majority (71%) of countries update the patient classification system and/or payment tariffs on an annual basis to try to account for new technologies. Use of short-term separate or supplementary payments for new technologies occurs in 79% of countries to ensure adequate funding and facilitate adoption. A minority (43%) of countries use evidence of therapeutic benefit and/or costs to determine or update payment tariffs, although it is somewhat more common in establishing short-term payments. The main barrier to using evidence is uncertain or unavailable clinical evidence. Almost three-fourths of respondents believed diagnosis-related group systems incentivize or deter technology adoption, depending on the particular circumstances. Improvements are needed, such as enhanced strategies for evidence generation and linking evidence of value to payments, national and international collaboration and training to improve existing practice, and flexible timelines for short-term payments. Importantly, additional research is needed to understand how different payment policies impact technology uptake as well as quality of care and costs.
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Barbieri M, Weatherly HLA, Ara R, Basarir H, Sculpher M, Adams R, Ahmed H, Coles C, Guerrero-Urbano T, Nutting C, Powell M. What is the quality of economic evaluations of non-drug therapies? A systematic review and critical appraisal of economic evaluations of radiotherapy for cancer. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:497-510. [PMID: 25060829 PMCID: PMC4175431 DOI: 10.1007/s40258-014-0115-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Breast, cervical and colorectal cancers are the three most frequent cancers in women, while lung, prostate and colorectal cancers are the most frequent in men. Much attention has been given to the economic evaluation of pharmaceuticals for treatment of cancer by the National Institute for Health and Care Excellence (NICE) in the UK and similar authorities internationally, while economic analysis developed for other types of anti-cancer interventions, including radiotherapy and surgery, are less common. OBJECTIVES Our objective was to review methods used in published cost-effectiveness studies evaluating radiotherapy for breast, cervical, colorectal, head and neck and prostate cancer, and to compare the economic evaluation methods applied with those defined in the guidelines used by the NICE technology appraisal programme. METHODS A systematic search of seven databases (MEDLINE, EMBASE, CDSR, NHSEED, HTA, DARE, EconLit) as well as research registers, the NICE website and conference proceedings was conducted in July 2012. Only economic evaluations of radiotherapy interventions in individuals diagnosed with cancer that included quality-adjusted life-years (QALYs) or life-years (LYs) were included. Included studies were appraised on the basis of satisfying essential, preferred and UK-specific methods requirements, building on the NICE Reference Case for economic evaluations and on other methods guidelines. RESULTS A total of 29 studies satisfied the inclusion criteria (breast 14, colorectal 2, prostate 10, cervical 0, head and neck 3). Only two studies were conducted in the UK (13 in the USA). Among essential methods criteria, the main issue was that only three (10%) of the studies used clinical-effectiveness estimates identified through systematic review of the literature. Similarly, only eight (28%) studies sourced health-related quality-of-life data directly from patients with the condition of interest. Other essential criteria (e.g. clear description of comparators, patient group indication and appropriate time horizon) were generally fulfilled, while most of the UK-specific requirements were not met. CONCLUSION Based on this review there is a dearth of up-to-date, robust evidence on the cost effectiveness of radiotherapy in cancer suitable to support decision making in the UK. Studies selected did not fully satisfy essential method standards currently recommended by NICE.
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Affiliation(s)
- M Barbieri
- Centre for Health Economics (CHE), University of York, Heslington, York, YO10 5DD, UK,
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Chapman AM, Taylor CA, Girling AJ. Are the UK systems of innovation and evaluation of medical devices compatible? The role of NICE's Medical Technologies Evaluation Programme (MTEP). APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:347-357. [PMID: 24934924 DOI: 10.1007/s40258-014-0104-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The economic evaluation of medical products and services is increasingly prioritised by healthcare decision makers and plays a key role in informing funding allocation decisions. It is well known that there are a number of methodological difficulties in the health technology assessment of medical devices, particularly in the provision of efficacy evidence. By contrasting devices with pharmaceuticals, the way in which the differing systems of innovation mould the UK's industry landscape is described and substantiated with market statistics. In recognition of the challenges faced by industry, as well as the growing need for cost-effective allocation of National Health Service (NHS) resources, the National Institute for Health and Care Excellence (NICE) led the development of the Medical Technologies Evaluation Programme (MTEP), which launched in 2009/2010. The review of the UK's medical devices market supports the programme's three principal aims: to simplify access to evaluation, speed up the process, and increase evaluative capacity for devices within NICE. However, an analysis of the output of MTEP's first 3 years suggests that it has some way to go to meet each of these aims.
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Affiliation(s)
- A M Chapman
- Office of Health Economics, 7th floor Southside, 105 Victoria Street, London, SW1E 6QT, UK,
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Lee SS, Salole E. Medical device reimbursement coverage and pricing rules in Korea: current practice and issues with access to innovation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:476-481. [PMID: 24969010 DOI: 10.1016/j.jval.2014.03.1719] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 06/03/2023]
Abstract
The development of health funding policy in Korea has followed the country's rapid economic development, with a comprehensive National Health Insurance (NHI) system in place by 1989. The funding of medical devices has followed this progression, with incorporation into the NHI reimbursement system in 2000 (several years later than pharmaceuticals), but important issues affecting patient access remain. Although the effect of devices on the NHI budget is relatively modest (only about 4%), because of concerns about NHI sustainability, attention has increasingly been paid to their management and funding. Unlike pharmaceuticals, however, it has been quite challenging to develop clear and fair criteria for reimbursement coverage and pricing of medical devices. The two key and longstanding issues around the reimbursement of medical devices in Korea are how to expedite market entry of improved or innovative medical devices at appropriate prices, and how to satisfactorily lower the reimbursement levels of older devices, thereby making headroom for new technologies to be reimbursed. Despite protracted discussions over the last decade, industry and government have been unable to reach full agreement. There has been some progress (e.g., introduction of the Value Appraisal and the Revaluation Systems), but there remains urgent need for productive discussion and consensus between government and industry regarding reasonable funding rules, transparency, and clarity in the reimbursement pricing process for medical devices.
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Green W, Hutton J. Health technology assessments in England: an analysis of the NICE Medical Technologies Evaluation Programme. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2014; 15:449-452. [PMID: 24212358 DOI: 10.1007/s10198-013-0539-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/16/2013] [Indexed: 06/02/2023]
Affiliation(s)
- William Green
- York Health Economics Consortium, University of York, Market Square, Heslington, York, YO10 5NH, UK,
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Sorenson C, Drummond M, Burns LR. Evolving reimbursement and pricing policies for devices in Europe and the United States should encourage greater value. Health Aff (Millwood) 2014; 32:788-96. [PMID: 23569060 DOI: 10.1377/hlthaff.2012.1210] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rising health care costs are an international concern, particularly in the United States, where spending on health care outpaces that of other industrialized countries. Consequently, there is growing desire in the United States and Europe to take a more value-based approach to health care, particularly with respect to the adoption and use of new health technology. This article examines medical device reimbursement and pricing policies in the United States and Europe, with a particular focus on value. Compared to the United States, Europe more formally and consistently considers value to determine which technologies to cover and at what price, especially for complex, costly devices. Both the United States and Europe have introduced policies to provide temporary coverage and reimbursement for promising technologies while additional evidence of value is generated. But additional actions are needed in both the United States and Europe to ensure wise value-based reimbursement and pricing policies for all devices, including the generation of better pre- and postmarket evidence and the development of new methods to evaluate value and link evidence of value to reimbursement.
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Boriani G, Braunschweig F, Deharo JC, Leyva F, Lubiński A, Lazzaro C. Impact of extending device longevity on the long-term costs of implantable cardioverter-defibrillator therapy: a modelling study with a 15-year time horizon. Europace 2013; 15:1453-1462. [DOI: 10.1093/europace/eut133] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Calciolari S, Torbica A, Tarricone R. Explaining the health costs associated with managing intracranial aneurysms in Italy. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:427-435. [PMID: 23839310 DOI: 10.1007/s40258-013-0041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The clinical management of intracranial aneurysms is debated in many countries because of the associated disability risk and costs. Therefore, estimating the costs and explaining their variability will provide important information for decision makers. OBJECTIVE We aimed to evaluate the acute and post-acute health costs of intracranial aneurysm management and to explain the variability in these costs in the Italian National Health System. METHODS An observational study was conducted on 145 patients who were affected by a (single) ruptured or an unruptured intracranial aneurysm. They were consecutively admitted to 14 Italian hospitals between October 2005 and March 2007. The data collected during the initial hospitalization and three follow-up visits were used to assess the 1-year health costs and the patients' health status after discharge. Two multivariate regression models were used to explain the variability in the acute and post-acute costs. RESULTS The average total cost per patient was <euro>30,813 (evaluation year: 2012). The first model explained the acute costs fairly well and showed that the severity of illness, the admission unit (i.e., intensive care unit vs. another unit of the hospital), and mortality were associated with large, significant (p < 0.05) coefficients. The second model outperformed the first one in explaining the post-acute costs and showed that health status assessed 30 days after discharge was a significant (p < 0.05) predictor of costs. CONCLUSION Policies aimed at containing health costs should focus on interventions that help to reduce disability, which is a key predictor of long-term costs.
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Affiliation(s)
- Stefano Calciolari
- Università della Svizzera italiana, Via Giuseppe Buffi, 13, 6904, Lugano, Switzerland.
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Sorenson C, Drummond M, Bhuiyan Khan B. Medical technology as a key driver of rising health expenditure: disentangling the relationship. CLINICOECONOMICS AND OUTCOMES RESEARCH 2013; 5:223-34. [PMID: 23807855 PMCID: PMC3686328 DOI: 10.2147/ceor.s39634] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Indexed: 11/27/2022] Open
Abstract
Health care spending has risen steadily in most countries, becoming a concern for decision-makers worldwide. Commentators often point to new medical technology as the key driver for burgeoning expenditures. This paper critically appraises this conjecture, based on an analysis of the existing literature, with the aim of offering a more detailed and considered analysis of this relationship. Several databases were searched to identify relevant literature. Various categories of studies (eg, multivariate and cost-effectiveness analyses) were included to cover different perspectives, methodological approaches, and issues regarding the link between medical technology and costs. Selected articles were reviewed and relevant information was extracted into a standardized template and analyzed for key cross-cutting themes, ie, impact of technology on costs, factors influencing this relationship, and methodological challenges in measuring such linkages. A total of 86 studies were reviewed. The analysis suggests that the relationship between medical technology and spending is complex and often conflicting. Findings were frequently contingent on varying factors, such as the availability of other interventions, patient population, and the methodological approach employed. Moreover, the impact of technology on costs differed across technologies, in that some (eg, cancer drugs, invasive medical devices) had significant financial implications, while others were cost-neutral or cost-saving. In light of these issues, we argue that decision-makers and other commentators should extend their focus beyond costs solely to include consideration of whether medical technology results in better value in health care and broader socioeconomic benefits.
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Affiliation(s)
- Corinna Sorenson
- LSE Health, London School of Economics and Political Science, London, UK
- European Health Technology Institute for Socioeconomic Research, Brussels, Belgium
| | - Michael Drummond
- European Health Technology Institute for Socioeconomic Research, Brussels, Belgium
- Centre for Health Economics, University of York, York, UK
| | - Beena Bhuiyan Khan
- LSE Health, London School of Economics and Political Science, London, UK
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Kirisits A, Redekop WK. The economic evaluation of medical devices: challenges ahead. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:15-26. [PMID: 23329383 DOI: 10.1007/s40258-012-0006-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The economic evaluation of medical technology has evolved as a key element in supporting health budget allocation decisions. Among suppliers of innovation, the medical device industry is one of the most dynamic fields of medical progress with thousands of new products marketed every year. Accordingly, the broad variety of technologies covered by the umbrella term 'medical devices' have come under increasing scrutiny regarding their cost effectiveness. In the process, a number of device-specific factors have become apparent, each of which can complicate a thorough economic evaluation and limit its informative value. Some of these factors relate to specific characteristics of device functioning. Examples of such factors include the fact that most technologies require, or form part of, a procedure and that many devices have multiple indications or purposes. Others in turn reflect external conditions and are more general in character, such as the regulatory framework that a medical device manufacturer faces prior to market approval and the structure of the medical device industry. Drawing on the available literature, these complicating factors and their practical implications are discussed and used as a basis to elaborate on the emerging challenges for the economic evaluation of medical devices.
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Affiliation(s)
- Andreas Kirisits
- Erasmus University Rotterdam, Institute of Health Policy and Management, The Netherlands
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Craven MP, Allsop MJ, Morgan SP, Martin JL. Engaging with economic evaluation methods: insights from small and medium enterprises in the UK medical devices industry after training workshops. Health Res Policy Syst 2012; 10:29. [PMID: 22943625 PMCID: PMC3507868 DOI: 10.1186/1478-4505-10-29] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 08/23/2012] [Indexed: 11/10/2022] Open
Abstract
Background With increased governmental interest in value assessment of technologies and where medical device manufacturers are finding it increasingly necessary to become more familiar with economic evaluation methods, the study sought to explore the levels of health economics knowledge within small and medium-sized enterprises (SMEs) and to scope strategies they employ to demonstrate the value of their products to purchasers. Methods A short questionnaire was completed by participants attending one of five workshops on product development in the medical device sector that took place in England between 2007 and 2011. From all responses obtained, a large proportion of participants were based in SMEs (N = 43), and these responses were used for the analysis. Statistical analysis using non-parametric tests was performed on questions with approximately interval scales. Qualitative data from participant responses were analysed to reveal emerging themes. Results The questionnaire results revealed that 60% of SME participants (mostly company directors or managers, including product or project managers) rated themselves as having low or no knowledge of health economics prior to the workshops but the rest professed at least medium knowledge. Clinical trials and cost analyses or cost-effectiveness studies were the most highly cited means by which SMEs aim to demonstrate value of products to purchasers. Purchasers were perceived to place most importance on factors of safety, expert opinion, cost-effectiveness and price. However many companies did not utilise formal decision-making tools to prioritise these factors. There was no significant dependence of the use of decision-making tools in general with respect to professed knowledge of health economics methods. SMEs did not state a preference for any particular aspect of potential value when deciding whether to develop a product. A majority of SMEs stated they would use a health economics tool. Research and development teams or marketing and sales departments would most likely use one. Conclusion This study points to the need for further research into the education requirements of SMEs in the area of Health Technology Assessment (HTA) and also for investigation into how SMEs engage with existing HTA processes as required by assessors such as NICE.
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Affiliation(s)
- Michael P Craven
- University of Nottingham, Faculty of Engineering, Tower Building, University Park, Nottingham, NG7 2RD, UK.
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