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Bloemen B, Oortwijn W. Assessing medical devices: a qualitative study from the validate perspective. Int J Technol Assess Health Care 2024; 40:e29. [PMID: 38654522 DOI: 10.1017/s0266462324000254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVES Our objective was to explore procedures and methods used at health technology assessment (HTA) agencies for assessing medical devices and the underlying views of HTA practitioners about appropriate methodology to identify challenges in adopting new methodologies for assessing devices. We focused on the role of normative commitments of HTA practitioners in the adoption of new methods. METHODS An online survey, including questions on procedures, scoping, and assessments of medical devices, was sent to members of the International Network of Agencies for Health Technology Assessment. Interviews were conducted with survey respondents and HTA practitioners involved in assessments of transcatheter aortic valve implantation to gain an in-depth understanding of choices made and views about assessing medical devices. Survey and interview questions were inspired by the "values in doing assessments of health technologies" approach towards HTA, which states that HTA addresses value-laden questions and information. RESULTS The current practice of assessing medical devices at HTA agencies is predominantly based on procedures, methods, and epistemological principles developed for assessments of drugs. Both practical factors (available time, demands of decision-makers, existing legal frameworks, and HTA guidelines), as well as commitments of HTA practitioners to principles of evidence-based medicine, make the adoption of a new methodology difficult. CONCLUSIONS There is a broad recognition that assessments of medical devices may need changes in HTA methodology. In order to realize this, the HTA community may require both a discussion on the role, responsibility, and goals of HTA, and resulting changes in institutional context to adopt new methodologies.
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Affiliation(s)
- Bart Bloemen
- IQ Health Science Department, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wija Oortwijn
- IQ Health Science Department, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands
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Muniappan S, Jeyaraman M, Yadav S, Jeyaraman N, Muthu S, Ramasubramanian S, Patro BP. Applications of Blockchain-Based Technology for Healthcare Devices Post-market Surveillance. Cureus 2024; 16:e57881. [PMID: 38725738 PMCID: PMC11079575 DOI: 10.7759/cureus.57881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
The volume of data analysis for medical device post-market surveillance (PMS) has increased dramatically in recent years. It is the more stringent and intricate regulatory criteria of the health authorities that are meant to improve the medical device safety review. As regulators scrutinize device safety more closely, proactive approaches to PMS processes are becoming crucial. To solve some of the issues brought on by this shifting regulatory landscape, new technologies have been investigated. This study envisages the technical features of blockchain technology (BCT) and its role in enhancing the PMS for medical devices. To address the aforementioned challenges, our model involves the establishment of a secure, permissioned blockchain for PMS data management, utilizing a proof-of-authority consensus mechanism. This blockchain framework will exclusively permit a carefully vetted and designated set of participants to validate transactions and record them in the PMS data ledger. The utilization of BCT holds the potential to introduce enhanced efficiency and provide several advantages to the various stakeholders involved in the PMS procedure, including its potential to support emerging regulatory efforts.
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Affiliation(s)
- Swarna Muniappan
- Electronics and Communication Engineering, Dr MGR Educational and Research Institute, Chennai, IND
| | - Madhan Jeyaraman
- Clinical Research, Viriginia Tech India, Dr MGR Educational and Research Institute, Chennai, IND
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore, IND
| | - Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
| | - Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
| | - Sathish Muthu
- Department of Orthopaedics, Government Karur Medical College, Karur, IND
- Department of Orthopaedics, Orthopaedic Research Group, Coimbatore, IND
- Department of Biotechnology, Faculty of Engineering, Karpagam Academy of Higher Education, Coimbatore, IND
| | | | - Bishnu P Patro
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
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Miranda R, Silvério R, Baptista FM, Oliveira MD. Unlocking Continuous Improvement in Heart Failure Remote Monitoring: A Participatory Approach to Unveil Value Dimensions and Performance Indicators. Telemed J E Health 2024. [PMID: 38436266 DOI: 10.1089/tmj.2023.0560] [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: 03/05/2024] Open
Abstract
Introduction: Heart failure (HF) constitutes a public health concern affecting quality of life, survival, and costs. Remote patient monitoring (RPM) can enhance HF management, involving patients actively and improving follow-up. While current HF RPM assessments emphasise cost-effectiveness analysis, there is a need to consider wider RPM impacts and integrate stakeholders' perspectives into assessments for better comprehensiveness. Methods: We developed a four-stage participatory approach to select value dimensions and indicators for continuous HF RPM assessment: Stage 1 involved building a literature-informed initial list; Stage 2 utilized expert interviews for validation and list expansion; Stage 3 involved a web-Delphi process with Portuguese stakeholders and experts for agreement assessment; and Stage 4 included a conclusive expert interview. Results: A literature review identified fourteen studies on telehealth, RPM, and HF, informing an initial list of four value dimensions (Access, Clinical aspects, Acceptability, and Costs) and 22 indicators. Seven semistructured interviews validated and further adjusted the list to 38 indicators. Subsequently, the web-Delphi process engaged 29 stakeholders, giving their opinions regarding assessment aspects' relevance and proposing additional elements - 1 dimension and 12 indicators. Five value dimensions and 38 indicators (76.0%) reached group agreement for selection, while 12 did not reach an agreement. Upon expert appreciation, 5 dimensions, 43 indicators, and 6 case-mix parameters were considered relevant. Discussion: This comprehensive social approach captured diverse stakeholder perspectives, achieving agreement on pertinent HF RPM monitoring and evaluation indicators. Findings can inform visualization and management tool development, aiding day-to-day RPM evaluation and identification of improvement opportunities.
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Affiliation(s)
- Rafael Miranda
- Centro de Estudos de Gestão do Instituto Superior Técnico, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- Enterprise Services Portugal, Siemens Healthineers, Erlangen, Germany
| | - Rita Silvério
- Centro de Estudos de Gestão do Instituto Superior Técnico, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | | | - Mónica Duarte Oliveira
- Centro de Estudos de Gestão do Instituto Superior Técnico, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
- iBB-Institute for Bioengineering and Biosciences and i4HB-Associate Laboratory Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
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Afonso S, Vieira ACL, Pereira C, Oliveira MD. Advancing hospital-based health technology assessment: evaluating genomic panel contracting strategies for blood tumors through a multimethodology. Int J Technol Assess Health Care 2023; 39:e76. [PMID: 38130159 DOI: 10.1017/s0266462323002751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The adoption of genomic technologies in the context of hospital-based health technology assessment presents multiple practical and organizational challenges. OBJECTIVE This study aimed to assist the Instituto Português de Oncologia de Lisboa Francisco Gentil (IPO Lisboa) decision makers in analyzing which acute myeloid leukemia (AML) genomic panel contracting strategies had the highest value-for-money. METHODS A tailored, three-step approach was developed, which included: mapping clinical pathways of AML patients, building a multicriteria value model using the MACBETH approach to evaluate each genomic testing contracting strategy, and estimating the cost of each strategy through Monte Carlo simulation modeling. The value-for-money of three contracting strategies - "Standard of care (S1)," "FoundationOne Heme test (S2)," and "New diagnostic test infrastructure (S3)" - was then analyzed through strategy landscape and value-for-money graphs. RESULTS Implementing a larger gene panel (S2) and investing in a new diagnostic test infrastructure (S3) were shown to generate extra value, but also to entail extra costs in comparison with the standard of care, with the extra value being explained by making available additional genetic information that enables more personalized treatment and patient monitoring (S2 and S3), access to a broader range of clinical trials (S2), and more complete databases to potentiate research (S3). CONCLUSION The proposed multimethodology provided IPO Lisboa decision makers with comprehensive and insightful information regarding each strategy's value-for-money, enabling an informed discussion on whether to move from the current Strategy S1 to other competing strategies.
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Affiliation(s)
- Susana Afonso
- CEGIST, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Ana C L Vieira
- CEGIST, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Carla Pereira
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPO Lisboa), Lisbon, Portugal
| | - Mónica D Oliveira
- CEGIST, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
- iBB - Institute for Bioengineering and Biosciences and i4HB - Associate Laboratory Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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Fontrier AM, Kamphuis B, Kanavos P. How can health technology assessment be improved to optimise access to medicines? Results from a Delphi study in Europe : Better access to medicines through HTA. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023:10.1007/s10198-023-01637-z. [PMID: 37917290 DOI: 10.1007/s10198-023-01637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 10/02/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Access to medicines is a shared goal across healthcare stakeholders. Since health technology assessment (HTA) informs funding decisions, it shapes access to medicines. Despite its wide implementation, significant access variations due to HTA are observed across Europe. This paper elicited the opinions of European stakeholders on how HTA can be improved to facilitate access. METHODS A scoping review identified HTA features that influence access to medicines within markets and areas for improvement, while three access dimensions were identified (availability, affordability, timeliness). Using the Delphi method, we elicited the opinions of European stakeholders to validate the literature findings. RESULTS Nineteen participants from 14 countries participated in the Delphi panel. Thirteen HTA features that could be improved to optimise access to medicines in Europe were identified. Of these, 11 recorded a positive impact on at least one of the three access dimensions. HTA features had mostly a positive impact on timeliness and a less clear impact on affordability. 'Early scientific advice' and 'clarity in evidentiary requirements' showed a positive impact on all access dimensions. 'Established ways to deal with uncertainty during HTA' could improve medicines' availability and timeliness, while more 'reliance on real-world evidence' could expedite time to market access. CONCLUSIONS Our results reiterate that increased transparency during HTA and the decision-making processes is essential; the use of and reliance on new evidence generation such as real-world evidence can optimise the availability of medicines; and better collaborations between regulatory institutions within and between countries are paramount for better access to medicines.
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Affiliation(s)
- Anna-Maria Fontrier
- LSE Health-Medical Technology Research Group and Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Bregtje Kamphuis
- LSE Health-Medical Technology Research Group and Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Panos Kanavos
- LSE Health-Medical Technology Research Group and Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Quoc TT, Bácskay I, Fehér P, Pallér Á, Papp B, Bíró K, Ujhelyi Z. Personalized Nasal Protective Devices: Importance and Perspectives. Life (Basel) 2023; 13:2116. [PMID: 38004256 PMCID: PMC10672262 DOI: 10.3390/life13112116] [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: 08/28/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023] Open
Abstract
Nowadays, in addition to diseases caused by environmental pollution, the importance of personalized protection against various infectious agents has become of paramount importance. Besides medicine, several technical and technological studies have been carried out to develop suitable devices. One such revolutionary solution is the use of personalized nasal filters, which allow our body to defend itself more effectively against external environmental damage and pathogens. These filters are small devices that are placed in the nose and specifically filter the inhaled environmental contaminants, allergens, and microorganisms according to individual needs. These devices not only play a key role in maintaining our health but also contribute to environmental protection, reducing the inhalation of pollutants and their harmful impact on the natural environment. Another advantage of personalized filters is that they also provide an opportunity to strengthen our individual immune systems. The use of personalized filters allows medicine to provide optimized protection for everyone, focusing on individual genetic and immunological conditions. The momentum behind the development and research of personalized nasal filters has reached astonishing proportions today. Nowadays, many research groups and medical institutions are working to create new materials, nanotechnologies, and bioinformatics solutions in order to create even more effective personalized nasal filters that can also be shaped easily and safely. Considering the needs of the users is at least as important during development as the efficiency of the device. These two properties together determine the success of the product. Industry research focuses not only on improving the efficiency of devices, but also on making them more responsive to user needs, comfort, and portability. Based on all this, it can be concluded that personalized nasal filters can be a promising and innovative solution for protection against environmental pollutants and pathogens. Through a commitment to the research and development of technology, the long-term impact of such devices on our health and the environment can be significant, contributing to improving people's quality of life and creating a sustainable future. With unique solutions and continuous research, we give hope that in the future, despite the environmental challenges, we can enjoy the protection of our health with even more efficient and sophisticated devices.
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Affiliation(s)
- Thinh To Quoc
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary; (T.T.Q.); (I.B.); (P.F.); (Á.P.); (B.P.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary;
| | - Ildikó Bácskay
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary; (T.T.Q.); (I.B.); (P.F.); (Á.P.); (B.P.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary;
- Institute of Healthcare Industry, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary
| | - Pálma Fehér
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary; (T.T.Q.); (I.B.); (P.F.); (Á.P.); (B.P.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary;
| | - Ádám Pallér
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary; (T.T.Q.); (I.B.); (P.F.); (Á.P.); (B.P.)
| | - Boglárka Papp
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary; (T.T.Q.); (I.B.); (P.F.); (Á.P.); (B.P.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary;
| | - Krisztina Bíró
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary;
- Hospital Pharmacy at the University of Debrecen, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary
| | - Zoltán Ujhelyi
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary; (T.T.Q.); (I.B.); (P.F.); (Á.P.); (B.P.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, Nagyerdei Sqr 98, 4032 Debrecen, Hungary;
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