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Hyeraci G, Trippoli S, Rivano M, Messori A. Estimation of Value-Based Price for 48 High-Technology Medical Devices. Cureus 2023; 15:e39934. [PMID: 37287820 PMCID: PMC10243399 DOI: 10.7759/cureus.39934] [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: 06/04/2023] [Indexed: 06/09/2023] Open
Abstract
Value-based price is estimated quite frequently for medicines, but its application to medical devices is scarce. While some reports have been published in which this parameter has occasionally been determined for devices, no large-scale application has yet been reported. Our objective was to pursue a systematic analysis of the literature published on value-based prices of medical devices. Pertinent papers were selected upon the criterion that the value-based price was reported for the device examined. The real prices of the devices were compared with their values of value-based price and the ratios between real price versus value-based price were calculated. A total of 239 economic articles focused on high-technology medical devices were selected from a standard PubMed search. Among these, the proportion of analyses unsuitable for value-based price estimation was high (191/239; 80%), whereas adequate clinical and economic information for estimating this parameter was available in 48 cases (20%). Standard equations of cost-effectiveness were applied. The value-based price was determined according to a willingness-to-pay threshold of 60,000 € per quality-adjusted life year. Real prices of devices were compared with the corresponding estimates of value-based prices. From each analysis, we extracted also the value of incremental cost-effectiveness ratio (ICER). Our final dataset included 47 analyses because one was published twice. There were five analyses in which the ICER could be estimated for the treatment, but not for the device. In the dataset of 42 analyses with complete information, 36 out of 42 devices (86%) were found to have an ICER lower than the pre-specified threshold (favorable ICER). Three ICERs were borderline. A separate analysis was conducted on the other three devices that showed an ICER substantially greater than the threshold (unfavorable ICER). Regarding value-based prices, the values of real price were appreciably lower than the corresponding value-based price in 36 cases (86%). For three devices, the real price was substantially higher than the value-based price. In the remaining three cases, real prices and value-based prices were very similar. To our knowledge, this is the first experience in which a systematic analysis of the literature has been focused on the application of value-based pricing in the field of high-technology devices. Our results are encouraging and suggest a wider application of cost-effectiveness in this field.
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Affiliation(s)
- Giulia Hyeraci
- Health Sciences, Agenzia Regionale Toscana, Firenze, ITA
| | - Sabrina Trippoli
- Health Technology Assessment (HTA) Unit, Regione Toscana, Firenze, ITA
| | | | - Andrea Messori
- Health Technology Assessment (HTA) Unit, Regione Toscana, Firenze, ITA
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Boudewijns EA, Otten TM, Gobianidze M, Ramaekers BL, van Schayck OCP, Joore MA. Headroom Analysis for Early Economic Evaluation: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:195-204. [PMID: 36575333 DOI: 10.1007/s40258-022-00774-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The headroom analysis is an early economic evaluation that quantifies the highest price at which an intervention may still be cost effective. Currently, there is no comprehensive review on how it is applied. This study investigated the application of the headroom analysis, specifically (1) how the headroom analysis is framed (2) the analytical approach and sources of evidence used, and (3) how expert judgement is used and reported. METHODS A systematic search was conducted in PubMed, Embase, Web of Science, EconLit, and Google Scholar on 28 April 2022. Studies were eligible if they reported an application of the headroom analysis. Data were presented in tabular form and summarised descriptively. RESULTS We identified 42 relevant papers. The headroom analysis was applied to medicines (29%), diagnostic or screening tests (29%), procedures, programmes and systems (21%), medical devices (19%), and a combined test and device (2%). All studies used model-based analyses, with 40% using simple models and 60% using more comprehensive models. Thirty-three percent of the studies assumed perfect effectiveness of the health technology, while 67% adopted realistic assumptions. Ten percent of the studies calculated an effectiveness-seeking headroom instead of a cost-seeking headroom. Expert judgement was used in 71% of the studies; 23 studies (55%) used expert opinion, 6 studies (14%) used expert elicitation, and 1 study (2%) used both. CONCLUSIONS Because the application of the headroom analysis varies considerably, we recommend its appropriate use and clear reporting of analytical approaches, level of evidence available, and the use of expert judgement.
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Affiliation(s)
- Esther A Boudewijns
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Thomas M Otten
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Mariam Gobianidze
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Bram L Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Audouard E, Michel F, Pierroz V, Kim T, Rousselot L, Gillet-Legrand B, Dufayet-Chauffaut G, Buchmann P, Florea M, Khel A, Altynbekova K, Delgaldo C, Escudero E, Soler ABA, Cartier N, Piguet F, Folcher M. Bioelectronic cell-based device provides a strategy for the treatment of the experimental model of multiple sclerosis. J Control Release 2022; 352:994-1008. [PMID: 36370877 PMCID: PMC9733677 DOI: 10.1016/j.jconrel.2022.11.008] [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] [Received: 08/12/2022] [Revised: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022]
Abstract
Wireless powered optogenetic cell-based implant provides a strategy to deliver subcutaneously therapeutic proteins. Immortalize Human Mesenchymal Stem Cells (hMSC-TERT) expressing the bacteriophytochrome diguanylate cyclase (DGCL) were validated for optogenetic controlled interferon-β delivery (Optoferon cells) in a bioelectronic cell-based implant. Optoferon cells transcriptomic profiling was used to elaborate an in-silico model of the recombinant interferon-β production. Wireless optoelectronic device integration was developed using additive manufacturing and injection molding. Implant cell-based optoelectronic interface manufacturing was established to integrate industrial flexible compact low-resistance screen-printed Near Field Communication (NFC) coil antenna. Optogenetic cell-based implant biocompatibility, and device performances were evaluated in the Experimental Autoimmune Encephalomyelitis (EAE) mouse model of multiple sclerosis.
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Affiliation(s)
- Emilie Audouard
- NeuroGenCell, Paris Brain Institute – ICM, INSERM, CNRS, AP-HP, Sorbonne Université; Hôpital de la Pitié Salpêtrière, Paris, France
| | - Fanny Michel
- Department of Biosystems Science and Engineering, D-BSSE, ETH Zürich, Basel, Switzerland
| | - Vanessa Pierroz
- Department of Biosystems Science and Engineering, D-BSSE, ETH Zürich, Basel, Switzerland
| | - Taeuk Kim
- Department of Biosystems Science and Engineering, D-BSSE, ETH Zürich, Basel, Switzerland
| | - Lisa Rousselot
- NeuroGenCell, Paris Brain Institute – ICM, INSERM, CNRS, AP-HP, Sorbonne Université; Hôpital de la Pitié Salpêtrière, Paris, France
| | - Béatrix Gillet-Legrand
- NeuroGenCell, Paris Brain Institute – ICM, INSERM, CNRS, AP-HP, Sorbonne Université; Hôpital de la Pitié Salpêtrière, Paris, France
| | - Gaëlle Dufayet-Chauffaut
- NeuroGenCell, Paris Brain Institute – ICM, INSERM, CNRS, AP-HP, Sorbonne Université; Hôpital de la Pitié Salpêtrière, Paris, France
| | - Peter Buchmann
- Department of Biosystems Science and Engineering, D-BSSE, ETH Zürich, Basel, Switzerland
| | - Michael Florea
- Department of Biosystems Science and Engineering, D-BSSE, ETH Zürich, Basel, Switzerland
| | | | | | - Claudia Delgaldo
- Eurecat, Centre Tecnològic de Catalunya, Functional Printing and Embedded Devices Unit, Mataró, Spain
| | - Encarna Escudero
- Eurecat, Centre Tecnològic de Catalunya, Functional Printing and Embedded Devices Unit, Mataró, Spain
| | - Alejandra Ben Aissa Soler
- Eurecat, Centre Tecnològic de Catalunya, Functional Printing and Embedded Devices Unit, Mataró, Spain
| | - Nathalie Cartier
- NeuroGenCell, Paris Brain Institute – ICM, INSERM, CNRS, AP-HP, Sorbonne Université; Hôpital de la Pitié Salpêtrière, Paris, France
| | - Francoise Piguet
- NeuroGenCell, Paris Brain Institute – ICM, INSERM, CNRS, AP-HP, Sorbonne Université; Hôpital de la Pitié Salpêtrière, Paris, France
| | - Marc Folcher
- Department of Biosystems Science and Engineering, D-BSSE, ETH Zürich, Basel, Switzerland,Institute of Molecular and Clinical Ophthalmology, IOB, Basel, Switzerland,Corresponding author at: Department of Biosystems Science and Engineering, D-BSSE, ETH Zürich, Basel, Switzerland.
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