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Basu R, Eggington S, Hallas N, Strachan L. Are Medical Device Characteristics Included in HTA Methods Guidelines and Reports? A Brief Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00896-y. [PMID: 38965161 DOI: 10.1007/s40258-024-00896-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/06/2024]
Abstract
It is well accepted that medical devices (MDs) and procedures have several unique characteristics compared with pharmaceuticals, such as learning curve (LC), incremental innovation (II), dynamic pricing (DP), and organizational impact (OI). The objective of this study was to determine the extent to which these MD characteristics are routinely assessed by health technology assessment (HTA) agencies and incorporated in their guidelines and reports. Three approaches were taken. First, a review of the most recent HTA methods guidelines from 14 selected HTA agencies and 5 HTA networks was undertaken. Next, HTA reports from these agencies were reviewed for inclusion of MD-specific characteristics for 16 selected MDs. Finally, a narrative literature review on this topic was conducted. A total of 13 of the included HTA organizations, and some HTA networks (2/5), have published either general or MD-specific method guidelines, whilst several addressed MD-specific characteristics. NICE included all four MD characteristics in their guidelines, but this did not equate to their inclusion in published HTA evaluations. European Network HTA (EUnetHTA) described the inclusion of LC (within patient safety) and OI within their guidance. The results highlight a lack of consistency. For the narrative review, 10/149 articles identified were reviewed. Most provided recommendations on challenges faced by HTAs, proposed steps to address uncertainties around MD characteristics and reported a lack of methodological guidance for evaluating MDs. A lack of inclusion of MD characteristics in HTA is a complex interplay of several important factors. For these characteristics to become a formal part of HTA of MDs in the future, clear guidance and frameworks are required to enable manufacturers to develop appropriate evidence, and HTA practitioners to assess their impact more broadly.
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Affiliation(s)
| | - Simon Eggington
- Medtronic International Trading Sàrl, Route du Molliau 31, 1131, Tolochenaz, Switzerland.
| | - Natalie Hallas
- Health Economics, Policy and Reimbursement, Medtronic UK and Ireland, Watford, WD18 8WW, United Kingdom
| | - Liesl Strachan
- Global Legal, Medtronic, 2 Alma Road, AUS-NSW North Ryde, Macquarie Park, NSW, 2113, Australia
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Albuquerque de Almeida F, Ricardo M. Different regulatory framework for medical devices and drugs in the European Union: Impact on clinical research and health technology assessments. Int J Health Plann Manage 2023; 38:1420-1434. [PMID: 37316973 DOI: 10.1002/hpm.3671] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES Understanding whether the regulatory framework in the European Union creates different standards for medical devices and drugs, assessing whether there is evidence on the impact of those standards on clinical and HTA research, and reflecting on findings in order to propose legislative changes for promoting a more efficient allocation of resources in the healthcare systems. METHODS Reviewing and comparing the legal framework for the approval of medical devices and drugs in the EU, with a particular focus on the changes brought by Regulation (EU) 2017/745. Investigating the available information on manufacturer sponsored clinical studies and HTA-supported recommendations for medical devices and drugs. RESULTS The review of the legislation identified different standards for approval of devices and drugs on their quality, safety, and performance/efficacy dimensions and fewer manufacturer sponsored clinical studies and HTA-supported recommendations for medical devices versus drugs. CONCLUSIONS Policy changes could be implemented in order to promote an integrated evidence-based assessment system for a better allocation of resources in healthcare, namely: a consensual classification of medical devices from an HTA perspective, which could be used as a guide for generating outcomes in clinical investigation, and the adoption of conditional coverage practices including mandatory post-approval evidence development for performing periodic technology assessments.
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Conrads-Frank A, Schnell-Inderst P, Neusser S, Hallsson LR, Stojkov I, Siebert S, Kühne F, Jahn B, Siebert U, Sroczynski G. Decision-analytic modeling for early health technology assessment of medical devices - a scoping review. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc11. [PMID: 36742459 PMCID: PMC9869403 DOI: 10.3205/000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 02/07/2023]
Abstract
Objective The goal of this review was to identify decision-analytic modeling studies in early health technology assessments (HTA) of high-risk medical devices, published over the last three years, and to provide a systematic overview of model purposes and characteristics. Additionally, the aim was to describe recent developments in modeling techniques. Methods For this scoping review, we performed a systematic literature search in PubMed and Embase including studies published in English or German. The search code consisted of terms describing early health technology assessment and terms for decision-analytic models. In abstract and full-text screening, studies were excluded that were not modeling studies for a high-risk medical device or an in-vitro diagnostic test. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was used to report on the search and exclusion of studies. For all included studies, study purpose, framework and model characteristics were extracted and reported in systematic evidence tables and a narrative summary. Results Out of 206 identified studies, 19 studies were included in the review. Studies were either conducted for hypothetical devices or for existing devices after they were already available on the market. No study extrapolated technical data from early development stages to estimate potential value of devices in development. All studies except one included cost as an outcome. Two studies were budget impact analyses. Most studies aimed at adoption and reimbursement decisions. The majority of studies were on in-vitro diagnostic tests for personalized and targeted medicine. A timed automata model, to our knowledge a model type new to HTA, was tested by one study. It describes the agents in a clinical pathway in separate models and, by allowing for interaction between the models, can reflect complex individual clinical pathways and dynamic system interactions. Not all sources of uncertainty for in-vitro tests were explicitly modeled. Elicitation of expert knowledge and judgement was used for substitution of missing empirical data. Analysis of uncertainty was the most valuable strength of decision-analytic models in early HTA, but no model applied sensitivity analysis to optimize the test positivity cutoff with regard to the benefit-harm balance or cost-effectiveness. Value-of-information analysis was rarely performed. No information was found on the use of causal inference methods for estimation of effect parameters from observational data. Conclusion Our review provides an overview of the purposes and model characteristics of nineteen recent early evaluation studies on medical devices. The review shows the growing importance of personalized interventions and confirms previously published recommendations for careful modeling of uncertainties surrounding diagnostic devices and for increased use of value-of-information analysis. Timed automata may be a model type worth exploring further in HTA. In addition, we recommend to extend the application of sensitivity analysis to optimize positivity criteria for in-vitro tests with regard to benefit-harm or cost-effectiveness. We emphasize the importance of causal inference methods when estimating effect parameters from observational data.
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Affiliation(s)
- Annette Conrads-Frank
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i. T., Austria
| | - Petra Schnell-Inderst
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i. T., Austria
| | - Silke Neusser
- Alfried Krupp von Bohlen and Halbach Foundation Endowed Chair for Medicine Management, University of Duisburg-Essen, Essen, Germany
| | - Lára R. Hallsson
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i. T., Austria
| | - Igor Stojkov
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i. T., Austria
| | - Silke Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i. T., Austria
| | - Felicitas Kühne
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i. T., Austria
| | - Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i. T., Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i. T., Austria,Center for Health Decision Science, Departments of Epidemiology and Health Policy & Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA,Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Division of Health Technology Assessment, ONCOTYROL – Center for Personalized Cancer Medicine, Innsbruck, Austria,*To whom correspondence should be addressed: Uwe Siebert, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Eduard-Wallnoefer-Zentrum 1, 6060 Hall i. T., Austria, Phone: +43 50 8648-3930, Twitter: @UweSiebert9, Linkedin: uwe-siebert9, E-mail:
| | - Gabi Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL – University for Health Sciences and Technology, Hall i. T., Austria
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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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Implementation of innovative medical technologies in German inpatient care: patterns of utilization and evidence development. Implement Sci 2021; 16:94. [PMID: 34717677 PMCID: PMC8556925 DOI: 10.1186/s13012-021-01159-3] [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: 06/18/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Innovative medical technologies are commonly associated with positive expectations. At the time of their introduction into care, there is often little evidence available regarding their benefits and harms. Accordingly, some innovative medical technologies with a lack of evidence are used widely until or even though findings of adverse events emerge, while others with study results supporting their safety and effectiveness remain underused. This study aims at examining the diffusion patterns of innovative medical technologies in German inpatient care between 2005 and 2017 while simultaneously considering evidence development. Methods Based on a qualitatively derived typology and a quantitative clustering of the adoption curves, a representative sample of 21 technologies was selected for further evaluation. Published scientific evidence on efficacy/effectiveness and safety of the technologies was identified and extracted in a systematic approach. Derived from a two-dimensional classification according to the degree of utilization and availability of supportive evidence, the diffusion patterns were then assigned to the categories “Success” (widespread/positive), “Hazard” (widespread/negative), “Overadoption” (widespread/limited or none), “Underadoption” (cautious/positive), “Vigilance” (cautious/negative), and “Prudence” (cautious/limited or none). Results Overall, we found limited evidence on the examined technologies regarding both the quantity and quality of published randomized controlled trials. Thus, the categories “Prudence” and “Overadoption” together account for nearly three-quarters of the years evaluated, followed by “Success” with 17%. Even when evidence is available, the transfer of knowledge into practice appears to be inhibited. Conclusions The successful implementation of safe and effective innovative medical technologies into practice requires substantial further efforts by policymakers to strengthen systematic knowledge generation and translation. Creating an environment that encourages the conduct of rigorous studies, promotes knowledge translation, and rewards innovative medical technologies according to their added value is a prerequisite for the diffusion of valuable health care. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01159-3.
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Iadanza E, Cerofolini S, Lombardo C, Satta F, Gherardelli M. Medical devices nomenclature systems: a scoping review. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-021-00567-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractInventory is a fundamental process throughout the life cycle of medical devices. The maintenance program for each piece of equipment must comply with current regulations that are constantly evolving. The need to set up an evidence based management of the inventory of thousands of medical devices hosted in the Careggi University Hospital (AOUC), in Florence (Italy), has suggested to conceive a method to group medical devices in sub-classes, in order to monitor their performances and maintenance. The starting point to reach this goal is to establish a suitable nomenclature, a complex system of rules, codes, and definitions employed by healthcare systems and organizations to identify sets of medical devices. This paper describes the literature search performed on both Ovid and Scopus databases, that made it possible to identify several classifications and nomenclatures for medical devices. On the basis of this search, only a few works fulfil the requirement of classifying medical devices for management purposes (e.g., inventories, database, and supply chains). The analysis has shown that it is possible to reduce the number of classes into macro groups when applying the Italian National Classification of Medical Devices (CND). Although the CND nomenclature shows inconsistencies for complex groups it is an effective and successful choice, in terms of efficiency and optimization, also considering that it is the basis for the European Medical Device Nomenclature (EMDN).
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Blüher M, Saunders SJ, Mittard V, Torrejon Torres R, Davis JA, Saunders R. Critical Review of European Health-Economic Guidelines for the Health Technology Assessment of Medical Devices. Front Med (Lausanne) 2019; 6:278. [PMID: 31850356 PMCID: PMC6895571 DOI: 10.3389/fmed.2019.00278] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/14/2019] [Indexed: 01/19/2023] Open
Abstract
Background: Health-technology assessment (HTA) is a recognized mechanism to determine the relative benefits of innovative medical technologies. One aspect is their health-economic impact. While the process and methodology for pharmaceuticals is well-established, guidance for medical devices is sparse. Aim: To provide an overview of the health-economic aspect in current European HTA guidelines concerning medical devices and identifying issues raised and potential improvements proposed in recent literature. Methodology: Available guidelines by European agencies were each reviewed and summarized. To complement this, a full systematic review of current literature concerning potential improvements to existing HTA practices for medical devices, from PubMed and EMBASE, was conducted; the focus was on health economics. Authors could only review documents in English, French, or German. The systematic review yielded 518 unique articles concerning HTA for medical devices, 32 of which were considered for full-text review after screening of all abstracts. Results: There is very limited consensus in—and mostly a complete lack of—guidance specific to medical devices in official HTA guidelines, for both clinical and economic analyses. Twenty two of 41 European countries had published official HTA guidance in English, French, or German. Among these only 4 (England, France, the Netherlands, and Sweden) dedicated a chapter or separate document to medical devices. In the literature, there is sufficient evidence to suggest medical devices need to be addressed separately from pharmaceuticals. However, mostly challenges are discussed rather than implementable solutions offered. We present the following set of frequently discussed issues and summarize any solutions that pertain to them: a weak evidence base, learning-curve effects, organizational impact, incremental innovation, diversity of devices, dynamic pricing, and transferability. We further combine reviewed information to suggest a set of possible best practices for health-economic assessment of medical devices. Conclusion: For greater efficiency in medical-device innovation, European agencies should look to (re-)address the specific requirements of medical devices in their HTA guidelines. When both the health-economic and data requirements for the HTA of medical devices are defined, the development of practical solutions will likely follow.
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EVIDENCE REQUIRED BY HEALTH TECHNOLGY ASSESSMENT AND REIMBURSEMENT BODIES EVALUATING DIAGNOSTIC OR PROGNOSTIC ALGORITHMS THAT INCLUDE OMICS DATA. Int J Technol Assess Health Care 2018; 34:368-377. [PMID: 30136642 DOI: 10.1017/s026646231800048x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Multi-analyte assays with algorithmic analyses (MAAAs) use combinations of circulating and clinical markers including omics-based sources for diagnostic and/or prognostic purposes. Assessing MAAAs is challenging under existing health technology assessment (HTA) methods or practices. We undertook a scoping review to explore the HTA methods used for MAAAs to identify the criteria used for clinical research and reimbursement purposes. METHODS This review included only non-companion (stand-alone) tests that are actionable and that have been evaluated by leading HTA or insurer/reimbursement bodies up to September 2017. RESULTS Twenty-five reports and articles evaluating seventeen MAAAs were examined, most of which have been developed in oncology. The two main models used were the EUnetHTA Core model and the Evaluation of Genomic Applications in Practice and Prevention ACCE framework. Clinical validity and utility criteria were used, as were economic, ethical, legal, and social aspects. Economic evidence on MAAAs was scarce, and there is no consensus on whether the perspectives used are sufficiently broad to include all relevant stakeholders. CONCLUSIONS Clinical utility and efficiency were the most used criteria, with stronger evidence needed linking the use of the algorithm with the clinical outcomes in real-life practice. HTA bodies must as well consider questions related to the analytical validity of MAAAs or with organizational aspects. The two main models, the EUnetHTA Core model and the ACCE framework, could be adapted to the assessment of MAAAs.
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Fuchs S, Olberg B, Perleth M, Busse R, Panteli D. Testing a new taxonomic model for the assessment of medical devices: Is it plausible and applicable? Insights from HTA reports and interviews with HTA institutions in Europe. Health Policy 2018; 123:173-181. [PMID: 29703653 DOI: 10.1016/j.healthpol.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 02/21/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Medical devices (MDs) encompass a broad and heterogeneous range of technologies. While practices vary considerably across countries, MDs often find application in patient care with little or no evaluation of their effectiveness and safety following market approval. A recently proposed taxonomy of MDs considered devices from the viewpoint of Health Technology Assessment (HTA). The aim of the work presented here was to test its plausibility and applicability by considering real-world HTA practices. METHODS HTA reports on MDs from European institutions were collected in a systematic manner and the evaluated devices and/or related procedures were matched to a position on the taxonomy. Following this, representatives from 16 European HTA institutions were asked about the usefulness of the taxonomy in semi-structured interviews. RESULTS 1237 HTA reports (2004-2015) from 33 European institutions were included in the sample. The majority of reports was on technologies from the taxonomic positions initially estimated as having high relevance. Most of the experts interviewed stated that they found the taxonomy useful, particularly regarding its potential to aid in selecting technologies for assessment and to highlight potential methodological particularities per taxonomic position. CONCLUSIONS Overall, the distribution of identified reports on the matrix confirmed that the initial estimation of the relevance and necessity of HTA provided in the taxonomic model is plausible. In addition, interviews with representatives of European HTA institutions showed that the taxonomy could be useful.
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Affiliation(s)
| | - Britta Olberg
- Berlin University of Technology, Germany; Federal Joint Committee, Berlin, Germany
| | - Matthias Perleth
- Berlin University of Technology, Germany; Federal Joint Committee, Berlin, Germany
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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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ANALYSIS OF DUPLICATION AND TIMING OF HEALTH TECHNOLOGY ASSESSMENTS ON MEDICAL DEVICES IN EUROPE. Int J Technol Assess Health Care 2017; 34:18-26. [PMID: 29258630 DOI: 10.1017/s0266462317001064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Strengthening efforts toward better collaboration plays a pivotal role in the assessment of medical devices to reduce overlap and save resources. This study explored the level of duplication in health technology assessments (HTA) of medical devices in Europe and their respective timing in order to identify areas for better collaboration. METHODS An analysis of European HTA reports of medical devices regarding overlaps in topics and timing in relation to market authorization was performed. We conducted a systematic search in the ADVANCE, Centre for Reviews and Dissemination, Syngerus, and POP databases, complemented by hand searching, to identify HTA reports published between 01/2003 and 07/2016 for a preselected cohort group of ten technologies. We analyzed the number of annual assessments per technology and evaluated activity patterns and timing in undertaking the HTA of the different institutes in Europe. RESULTS The results revealed the amount of duplication in the European HTA production: the number of reports per technology ranged from minimum seven to maximum twenty-two over a time-span of 13.5 years. HTA institutes perform assessments at a similar time range within 5 to 10 years following market authorization. The timing of the initial assessment in relation to the granting of the CE-mark varies according to the particular technology. CONCLUSION The findings suggest that efficient collaboration may help to save scarce resources and time of HTA institutes in Europe. Efficient collaboration as such needs to shift the focus beyond the time span of 1 year, and build on each's others work from previous assessments.
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Zippel C, Bohnet-Joschko S. Post market surveillance in the german medical device sector – current state and future perspectives. Health Policy 2017; 121:880-886. [DOI: 10.1016/j.healthpol.2017.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
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HEALTH TECHNOLOGY ASSESSMENT OF MEDICAL DEVICES IN EUROPE: PROCESSES, PRACTICES, AND METHODS. Int J Technol Assess Health Care 2016; 32:246-255. [DOI: 10.1017/s0266462316000349] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: To review and compare current Health Technology Assessment (HTA) activities for medical devices (MDs) across European HTA institutions.Methods: A comprehensive approach was adopted to identify institutions involved in HTA in European countries. We systematically searched institutional Web sites and other online sources by using a structured tool to extract information on the role and link to decision making, structure, scope, process, methodological approach, and available HTA reports for each included institution.Results: Information was obtained from eighty-four institutions, forty-seven of which were analyzed. Fifty-four methodological documents from twenty-three agencies in eighteen countries were identified. Only five agencies had separate documents for the assessment of MDs. A few agencies made separate provisions for the assessment of MDs in their general methods. The amount of publicly available HTA reports on MDs varied by device category and agency remit.Conclusions: Despite growing consensus on their importance and international initiatives, such as the EUnetHTA Core Model®, specific tools for the assessment of MDs are rarely developed and implemented at the national level. Separate additional signposts incorporated in existing general methods guides may be sufficient for the evaluation of MDs.
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Fuchs S, Olberg B, Panteli D, Perleth M, Busse R. HTA of medical devices: Challenges and ideas for the future from a European perspective. Health Policy 2016; 121:215-229. [PMID: 27751533 DOI: 10.1016/j.healthpol.2016.08.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/13/2016] [Accepted: 08/28/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Health Technology Assessment (HTA) of Medical devices (MDs) and MD-based procedures can be challenging due to the unique features and particularities of this group of technologies, such as device-operator interaction. The aim of this study was to (1) clarify, and supplement earlier findings on European HTA institutions' structural, procedural and methodological characteristics with regard to the assessment of MDs and to (2) capture the institutions' perceptions regarding challenges and future trends. METHODS Semi-structured telephone interviews with 16 representatives from leading European HTA institutions were performed between April and July 2015. Summative and directed content analysis was used for the analysis, which is reported according to the COREQ checklist. RESULTS Findings from the analysis of the interviews were manifold and partially confirmed what has been noted in the literature (e.g. scarce evidence; identifying relevant studies challenging due to more incremental innovations). Additional themes emerged that can be important for future considerations by HTA institutions and policy-makers alike (e.g. areas for future research; need for specific tools). CONCLUSIONS The collective opinion of 16 European HTA institutions on MD evaluation could provide ideas to ameliorate the current regulatory situation beyond the modified EU regulation and start broader, more in-depth methodological discussions around the issue. Interviewed experts seem to agree that new approaches such as coverage with evidence development as some countries already introduced could help to overcome the problem with scarce evidence.
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Affiliation(s)
- Sabine Fuchs
- Department of Health Care Management, Berlin University of Technology, Germany.
| | - Britta Olberg
- Department of Health Care Management, Berlin University of Technology, Germany; Medical Consultancy Department, Federal Joint Committee (G-BA), Germany
| | - Dimitra Panteli
- Department of Health Care Management, Berlin University of Technology, Germany
| | - Matthias Perleth
- Department of Health Care Management, Berlin University of Technology, Germany; Medical Consultancy Department, Federal Joint Committee (G-BA), Germany
| | - Reinhard Busse
- Department of Health Care Management, Berlin University of Technology, Germany
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