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Douglas CMW, Aith F, Boon W, de Neiva Borba M, Doganova L, Grunebaum S, Hagendijk R, Lynd L, Mallard A, Mohamed FA, Moors E, Oliveira CC, Paterson F, Scanga V, Soares J, Raberharisoa V, Kleinhout-Vliek T. Social pharmaceutical innovation and alternative forms of research, development and deployment for drugs for rare diseases. Orphanet J Rare Dis 2022; 17:344. [PMID: 36064440 PMCID: PMC9446828 DOI: 10.1186/s13023-022-02476-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/13/2022] [Indexed: 11/10/2022] Open
Abstract
Rare diseases are associated with difficulties in addressing unmet medical needs, lack of access to treatment, high prices, evidentiary mismatch, equity, etc. While challenges facing the development of drugs for rare diseases are experienced differently globally (i.e., higher vs. lower and middle income countries), many are also expressed transnationally, which suggests systemic issues. Pharmaceutical innovation is highly regulated and institutionalized, leading to firmly established innovation pathways. While deviating from these innovation pathways is difficult, we take the position that doing so is of critical importance. The reason is that the current model of pharmaceutical innovation alone will not deliver the quantity of products needed to address the unmet needs faced by rare disease patients, nor at a price point that is sustainable for healthcare systems. In light of the problems in rare diseases, we hold that re-thinking innovation is crucial and more room should be provided for alternative innovation pathways. We already observe a significant number and variety of new types of initiatives in the rare diseases field that propose or use alternative pharmaceutical innovation pathways which have in common that they involve a diverse set of societal stakeholders, explicitly address a higher societal goal, or both. Our position is that principles of social innovation can be drawn on in the framing and articulation of such alternative pathways, which we term here social pharmaceutical innovation (SPIN), and that it should be given more room for development. As an interdisciplinary research team in the social sciences, public health and law, the cases of SPIN we investigate are spread transnationally, and include higher income as well as middle income countries. We do this to develop a better understanding of the social pharmaceutical innovation field's breadth and to advance changes ranging from the bedside to system levels. We seek collaborations with those working in such projects (e.g., patients and patient organisations, researchers in rare diseases, industry, and policy makers). We aim to add comparative and evaluative value to social pharmaceutical innovation, and we seek to ignite further interest in these initiatives, thereby actively contributing to them as a part of our work.
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Affiliation(s)
- Conor M W Douglas
- Department of Science, Technology and Society, 307 Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Fernando Aith
- University of São Paulo Public Health School, Health Law Research Center of the University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil
| | - Wouter Boon
- Copernicus Institute of Sustainable Development, Universiteit Utrecht, Princetonlaan 8a, 3584 CB, Utrecht, The Netherlands
| | - Marina de Neiva Borba
- São Camilo Medical School, School of Public Health, University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil
| | - Liliana Doganova
- Mines ParisTech, Université PSL in Paris, 60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Shir Grunebaum
- Department of Science and Technology Studies, 307 Bethune College, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Rob Hagendijk
- Faculty of Social and Behavioural Sciences, International School of Social Sciences and Humanities, University of Amsterdam, Spui 2, 1012 WX, Amsterdam, The Netherlands
| | - Larry Lynd
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Alexandre Mallard
- Center for Social Innovation, Université PSL in Paris, Mines ParisTech60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Faisal Ali Mohamed
- Faculty of Health Policy and Equity, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Ellen Moors
- Innovation and Sustainability, Copernicus Institute of Sustainable Development, Universiteit Utrecht, Princetonlaan 8a, 3584 CB, Utrecht, The Netherlands
| | - Claudio Cordovil Oliveira
- Public Health at the Sergio Arouca National School of Public Health (ENSP/Fiocruz), Av. Brazil, 4365 - Manguinhos, Rio de Janeiro, Brazil
| | - Florence Paterson
- Mines ParisTech, Université PSL in Paris, 60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Vanessa Scanga
- Osgoode Hall Law School of York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Julino Soares
- The Federal University of Sao Paulo (UNIFESP), School of Public Health at the University of São Paulo, Av. Dr. Arnaldo, 715, São Paulo, Brazil
| | - Vololona Raberharisoa
- Mines ParisTech, Université PSL in Paris, 60 Boulevard Saint Michel, 75272, Paris Cedex 06, France
| | - Tineke Kleinhout-Vliek
- Geosciences, Innovation Studies, Innovation and Sustainability Institute, Universiteit Utrecht, Princetonlaan 8a, 3584 CB, Utrecht, The Netherlands
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2
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Ofori-Asenso R, Hallgreen CE, De Bruin ML. Improving Interactions Between Health Technology Assessment Bodies and Regulatory Agencies: A Systematic Review and Cross-Sectional Survey on Processes, Progress, Outcomes, and Challenges. Front Med (Lausanne) 2020; 7:582634. [PMID: 33178721 PMCID: PMC7596325 DOI: 10.3389/fmed.2020.582634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
The need to optimize drug development and facilitate faster access for patients has ignited discussions around the importance of improving interactions between health technology assessment (HTA) bodies and regulatory agencies. In this study, we conducted a systematic review to examine processes, progress, outcomes, and challenges of harmonization/interaction initiatives between HTA bodies and regulatory agencies. MEDLINE, EMBASE, and the International Pharmaceutical Abstracts database were searched up to 21 October 2019. Searches for gray literature (working papers, commissioned reports, policy documents, etc.) were performed via Google scholar and several institutional websites. An online cross-sectional survey was also conducted among HTA (n = 22) and regulatory agencies (n = 6) across Europe to supplement the systematic review. Overall, we found that while there are areas of divergence, there has been progress over time in narrowing the gap in evidentiary requirements for HTA bodies and regulatory agencies. Most regulatory agencies (4/6; 67%) and half (11/22, 50%) of the HTA bodies reported having a formal link for “collaborating” with the other. Several mechanisms such as early tripartite dialogues, parallel submissions (reviews), adaptive licensing pathways, and postauthorization data generation have been explored as avenues for improving collaboration. A number of pilot initiatives have shown positive effects of these models to reduce the time between regulatory and HTA decisions, which may translate into faster access for patients to life-saving therapies. Thus, future approaches aimed at improving harmonization/interaction between HTA bodies and regulatory agencies should build on these existing models/mechanisms while examining their long-term impacts. Several barriers including legal, organizational, and resource-related factors were also identified, and these need to be addressed to achieve greater alignment in the current regulatory and reimbursement landscape.
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Affiliation(s)
- Richard Ofori-Asenso
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christine E Hallgreen
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie Louise De Bruin
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
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3
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Schulthess D, Baird LG, Trusheim M, Unger TF, Lumpkin M, Hoos A, Garner S, Gavin P, Goldman M, Seigneuret N, Chlebus M, Van Baelen K, Bergstrom R, Hirsch G. Medicines Adaptive Pathways to Patients (MAPPs): A Story of International Collaboration Leading to Implementation. Ther Innov Regul Sci 2016; 50:347-354. [PMID: 30227070 DOI: 10.1177/2168479015618697] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
After nearly a decade of discussion, analysis, and development, the Medicines Adaptive Pathways to Patients (MAPPs) initiative is beginning to see acceptance from regulators, industry, patients, and payers, with the first live pilot project initiated under the guidance of the European Medicines Agency in 2014. Although it is a significant achievement to see the first asset being placed into human trials under an adaptive pathway, there is much to be learned regarding the multinational and multi-stakeholder effort that has driven the growing acceptance of MAPPs as a methodology and concept, as well as the need for continued and increasing international collaboration to foster the wider adoption of MAPPs. Changes in available science and technology, as well as a number of challenges in the current system, outlined in this paper, are transforming approaches to medicines development and approval. It is these challenges that have led directly to the groundbreaking MAPPs collaboration between the Massachusetts Institute of Technology Center for Biomedical Innovation's New Drug Development Paradigms Initiative, the EMA, patient, payer and health technology assessment groups, the European Federation of Pharmaceutical Industries and Associations, and the Innovative Medicines Initiative-a European public-private partnership. This article examines the development of MAPPs, from inception of the concept, to the establishment of this trans-Atlantic initiative, and examines challenges for the future.
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Affiliation(s)
| | - Lynn G Baird
- 2 MIT, Center for BioMedical Innovation, Cambridge, MA, USA
| | - Mark Trusheim
- 3 MIT Sloan School of Management, Cambridge, MA, USA
| | - Thomas F Unger
- 4 MIT, Regulatory Strategy, Cambridge, MA, USA.,5 Naia Pharma, Cayman Islands
| | | | - Anton Hoos
- 7 AMGEN, Medical for Europe, Zug, Switzerland
| | - Sarah Garner
- 8 National Institute for Health and Clinical Excellence, Research and Development, London, England
| | | | - Michel Goldman
- 10 Institute for Interdisciplinary Innovation in Healthcare, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | - Gigi Hirsch
- 2 MIT, Center for BioMedical Innovation, Cambridge, MA, USA
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4
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Trusheim MR, Shrier AA, Antonijevic Z, Beckman RA, Campbell RK, Chen C, Flaherty KT, Loewy J, Lacombe D, Madhavan S, Selker HP, Esserman LJ. PIPELINEs: Creating Comparable Clinical Knowledge Efficiently by Linking Trial Platforms. Clin Pharmacol Ther 2016; 100:713-729. [PMID: 27643536 PMCID: PMC5142736 DOI: 10.1002/cpt.514] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 12/16/2022]
Abstract
Adaptive, seamless, multisponsor, multitherapy clinical trial designs executed as large scale platforms, could create superior evidence more efficiently than single-sponsor, single-drug trials. These trial PIPELINEs also could diminish barriers to trial participation, increase the representation of real-world populations, and create systematic evidence development for learning throughout a therapeutic life cycle, to continually refine its use. Comparable evidence could arise from multiarm design, shared comparator arms, and standardized endpoints-aiding sponsors in demonstrating the distinct value of their innovative medicines; facilitating providers and patients in selecting the most appropriate treatments; assisting regulators in efficacy and safety determinations; helping payers make coverage and reimbursement decisions; and spurring scientists with translational insights. Reduced trial times and costs could enable more indications, reduced development cycle times, and improved system financial sustainability. Challenges to overcome range from statistical to operational to collaborative governance and data exchange.
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Affiliation(s)
- MR Trusheim
- MITCenter for Biomedical InnovationCambridgeMassachusettsUSA
| | - AA Shrier
- MITCenter for Biomedical InnovationCambridgeMassachusettsUSA
- Riptide ManagementCambridgeMassachusettsUSA
| | | | - RA Beckman
- Georgetown University Medical CenterLombardi Comprehensive Cancer Center and Innovation Center for Biomedical InformaticsWashingtonDCUSA
| | | | - C Chen
- Merck & Co.PhiladelphiaPennsylvaniaUSA
| | - KT Flaherty
- Massachusetts General Hospital Cancer CenterBostonMassachusettsUSA
| | - J Loewy
- DataForeThoughtWinchesterMassachusettsUSA
| | - D Lacombe
- European Organisation for Research and Treatment of Cancer (EORTC)BrusselsBelgium
| | - S Madhavan
- Georgetown University Medical CenterInnovation Center for Biomedical InformaticsWashingtonDCUSA
| | - HP Selker
- Tufts Medical Center and Tufts UniversityInstitute for Clinical Research and Health Policy Studies and Tufts Clinical and Translational Science InstituteBostonMassachusettsUSA
| | - LJ Esserman
- University of California San Francisco Medical CenterCarol Franc Buck Breast Care CenterSan FranciscoCaliforniaUSA
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5
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Faulkner SD, Lee M, Qin D, Morrell L, Xoxi E, Sammarco A, Cammarata S, Russo P, Pani L, Barker R. Pricing and reimbursement experiences and insights in the European Union and the United States: Lessons learned to approach adaptive payer pathways. Clin Pharmacol Ther 2016; 100:730-742. [DOI: 10.1002/cpt.508] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/10/2016] [Indexed: 12/24/2022]
Affiliation(s)
- SD Faulkner
- Centre for Advancement for Sustainable Medical Innovation (CASMI); University of Oxford; Oxford United Kingdom
| | - M Lee
- Price Waterhouse Cooper's Strategy&; London United Kingdom
| | - D Qin
- Price Waterhouse Cooper's Strategy&; London United Kingdom
| | - L Morrell
- Centre for Advancement for Sustainable Medical Innovation (CASMI); University of Oxford; Oxford United Kingdom
| | - E Xoxi
- Italian Medicines Agency; Rome Italy
| | | | | | - P Russo
- Italian Medicines Agency; Rome Italy
| | - L Pani
- Italian Medicines Agency; Rome Italy
| | - R Barker
- Centre for Advancement for Sustainable Medical Innovation (CASMI); University of Oxford; Oxford United Kingdom
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Hirsch G, Trusheim M, Cobbs E, Bala M, Garner S, Hartman D, Isaacs K, Lumpkin M, Lim R, Oye K, Pezalla E, Saltonstall P, Selker H. Adaptive Biomedical Innovation: Evolving Our Global System to Sustainably and Safely Bring New Medicines to Patients in Need. Clin Pharmacol Ther 2016; 100:685-698. [PMID: 27626610 PMCID: PMC5129677 DOI: 10.1002/cpt.509] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/24/2016] [Accepted: 08/31/2016] [Indexed: 01/10/2023]
Abstract
The current system of biomedical innovation is unable to keep pace with scientific advancements. We propose to address this gap by reengineering innovation processes to accelerate reliable delivery of products that address unmet medical needs. Adaptive biomedical innovation (ABI) provides an integrative, strategic approach for process innovation. Although the term "ABI" is new, it encompasses fragmented "tools" that have been developed across the global pharmaceutical industry, and could accelerate the evolution of the system through more coordinated application. ABI involves bringing stakeholders together to set shared objectives, foster trust, structure decision-making, and manage expectations through rapid-cycle feedback loops that maximize product knowledge and reduce uncertainty in a continuous, adaptive, and sustainable learning healthcare system. Adaptive decision-making, a core element of ABI, provides a framework for structuring decision-making designed to manage two types of uncertainty - the maturity of scientific and clinical knowledge, and the behaviors of other critical stakeholders.
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Affiliation(s)
- G Hirsch
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - M Trusheim
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - E Cobbs
- Merck, Kenilworth, New Jersey, USA
| | - M Bala
- Sanofi, Seattle, Washington, USA
| | - S Garner
- National Institute for Health and Clinical Excellence (NICE), London, UK
| | - D Hartman
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - K Isaacs
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - M Lumpkin
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - R Lim
- Health Canada, Ottawa, Ontario, Canada
| | - K Oye
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - P Saltonstall
- National Organization for Rare Disorders (NORD), Danbury, Connecticut, USA
| | - H Selker
- Tufts University, Boston, Massachusetts, USA
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7
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Towse A, Garau M, Mohr P, Messner DA. Futurescapes: expectations in Europe for relative effectiveness evidence for drugs in 2020. J Comp Eff Res 2015; 4:401-18. [PMID: 25740283 DOI: 10.2217/cer.15.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Explore key factors influencing future expectations for the production of evidence of relative effectiveness (RE) for drugs in Europe in 2020; construct three plausible future scenarios for RE evidence generation. MATERIALS & METHODS Semi-structured key informant interviews and three rounds of modified Delphi to gather expert perspectives and develop future scenarios. RESULTS & CONCLUSION Most influential factors were degree of regulator use of postmarketing authorization (postlaunch) efficacy studies and adaptive licensing; degree of pan-European health technology assessment body coordination in reviewing prelaunch evidence and demanding postlaunch studies; the nature of regulator - health technology assessment body interaction. The most likely scenario entailed some change with postlaunch regulatory studies driving the likely nature of RE evidence generated.
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Affiliation(s)
- Adrian Towse
- Office of Health Economics, 7th Floor, Southside, 105 Victoria Street, Westminster, London, SW1E 6QT, UK
| | - Martina Garau
- Office of Health Economics, 7th Floor, Southside, 105 Victoria Street, Westminster, London, SW1E 6QT, UK
| | - Penny Mohr
- Patient-Centered Outcomes Research Institute (PCORI), 1828 L Street, NW, 9th Floor, Washington, DC 20036, USA
| | - Donna A Messner
- Center for Medical Technology Policy, World Trade Center Baltimore, 401 East Pratt Street, Suite 631, Baltimore, MD 21202, USA
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Autorización progresiva: ¿un nuevo camino hacia el acceso temprano de nuevos medicamentos? Med Clin (Barc) 2015; 144:275-8. [DOI: 10.1016/j.medcli.2014.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/17/2014] [Indexed: 11/18/2022]
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Berndt ER, Trusheim MR. Biosimilar and Biobetter Scenarios for the US and Europe: What Should We Expect? BIOBETTERS 2015. [DOI: 10.1007/978-1-4939-2543-8_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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10
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Trusheim MR, Baird LG, Garner S, Lim R, Patel N, Hirsch G. The Janus initiative: A multi-stakeholder process and tool set for facilitating and quantifying Adaptive Licensing discussions. HEALTH POLICY AND TECHNOLOGY 2014. [DOI: 10.1016/j.hlpt.2014.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
When the late Freddie Mercury penned these words (1), perhaps he had in mind bringing innovative medicines and devices to patients more quickly.
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Adaptive approaches to licensing, health technology assessment, and introduction of drugs and devices. Int J Technol Assess Health Care 2014; 30:241-9. [PMID: 24921416 DOI: 10.1017/s0266462314000191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adaptive approaches to the introduction of drugs and medical devices involve the use of an evolving evidence base rather than conventional single-point-in-time evaluations as a proposed means to promote patient access to innovation, reduce clinical uncertainty, ensure effectiveness, and improve the health technology development process. METHODS This report summarizes a Health Technology Assessment International (HTAi) Policy Forum discussion, drawing on presentations from invited experts, discussions among attendees about real-world case examples, and background paper. RESULTS For adaptive approaches to be understood, accepted, and implemented, the Forum identified several key issues that must be addressed. These include the need to define the goals of and to set priorities for adaptive approaches; to examine evidence collection approaches; to clarify the roles and responsibilities of stakeholders; to understand the implications of adaptive approaches on current legal and ethical standards; to determine costs of such approaches and how they will be met; and to identify differences in applying adaptive approaches to drugs versus medical devices. The Forum also explored the different implications of adaptive approaches for various stakeholders, including patients, regulators, HTA/coverage bodies, health systems, clinicians, and industry. CONCLUSIONS A key outcome of the meeting was a clearer understanding of the opportunities and challenges adaptive approaches present. Furthermore, the Forum brought to light the critical importance of recognizing and including a full range of stakeholders as contributors to a shared decision-making model implicit in adaptive pathways in future discussions on, and implementation of, adaptive approaches.
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