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Ardito V, Cavallaro L, Drummond M, Ciani O. Mapping Payment and Pricing Schemes for Health Innovation: Protocol of a Scoping Literature Review. PHARMACOECONOMICS - OPEN 2024:10.1007/s41669-024-00496-5. [PMID: 38773050 DOI: 10.1007/s41669-024-00496-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 05/23/2024]
Abstract
INTRODUCTION Innovative pricing and payment/reimbursement schemes have been proposed as one part of the solution to the problem of patient access to new health technologies or to the uncertainty about their long-term effectiveness. As part of a Horizon Europe research project on health innovation next generation pricing and payment models (HI-PRIX), this protocol illustrates the conceptual and methodological steps related to a scoping review aiming at investigating nature and scope of pricing and payment/reimbursement schemes applied to, or proposed for, existing or new health technologies. METHODS A scoping review of literature will be performed according to the PRISMA guidelines for scoping reviews (PRISMA-ScR) guidelines. The search will be conducted in three scientific databases (i.e., PubMed, Web of Science, and Scopus), over a 2010-2023 timeframe. The search strategy is structured around two blocks of keywords, namely "pricing and payment/reimbursement schemes," and "innovativeness" (of the scheme type or scheme use). A simplified search will be replicated in the gray literature. Studies illustrating pricing and payment/reimbursement schemes with a sufficient level of details to explain their characteristics and functioning will be deemed eligible to be considered for data synthesis. Pricing and payment/reimbursement schemes will be classified according to several criteria, such as their purpose, nature, governance, data collection needs, and foreseen distribution of risk. The results will populate a publicly available online tool, the Pay-for-Innovation Observatory. DISCUSSION The findings of this review have the potential to offer a comprehensive toolkit with a variety of pricing and payment schemes to policymakers and manufacturers facing reimbursement and access decisions.
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Affiliation(s)
- Vittoria Ardito
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management, Via Sarfatti, 10, 20136, Milan, MI, Italy.
| | - Ludovico Cavallaro
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management, Via Sarfatti, 10, 20136, Milan, MI, Italy
| | - Michael Drummond
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management, Via Sarfatti, 10, 20136, Milan, MI, Italy
- Centre for Health Economics, University of York, York, UK
| | - Oriana Ciani
- Center for Research on Health and Social Care Management, SDA Bocconi School of Management, Via Sarfatti, 10, 20136, Milan, MI, Italy
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Baturalp TB, Bozkurt S. Design and Analysis of a Polymeric Left Ventricular Simulator via Computational Modelling. Biomimetics (Basel) 2024; 9:269. [PMID: 38786479 PMCID: PMC11117906 DOI: 10.3390/biomimetics9050269] [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: 03/17/2024] [Revised: 04/12/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024] Open
Abstract
Preclinical testing of medical devices is an essential step in the product life cycle, whereas testing of cardiovascular implants requires specialised testbeds or numerical simulations using computer software Ansys 2016. Existing test setups used to evaluate physiological scenarios and test cardiac implants such as mock circulatory systems or isolated beating heart platforms are driven by sophisticated hardware which comes at a high cost or raises ethical concerns. On the other hand, computational methods used to simulate blood flow in the cardiovascular system may be simplified or computationally expensive. Therefore, there is a need for low-cost, relatively simple and efficient test beds that can provide realistic conditions to simulate physiological scenarios and evaluate cardiovascular devices. In this study, the concept design of a novel left ventricular simulator made of latex rubber and actuated by pneumatic artificial muscles is presented. The designed left ventricular simulator is geometrically similar to a native left ventricle, whereas the basal diameter and long axis length are within an anatomical range. Finite element simulations evaluating left ventricular twisting and shortening predicted that the designed left ventricular simulator rotates approximately 17 degrees at the apex and the long axis shortens around 11 mm. Experimental results showed that the twist angle is 18 degrees and the left ventricular simulator shortens 5 mm. Twist angles and long axis shortening as in a native left ventricle show it is capable of functioning like a native left ventricle and simulating a variety of scenarios, and therefore has the potential to be used as a test platform.
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Affiliation(s)
- Turgut Batuhan Baturalp
- Department of Mechanical Engineering, Texas Tech University, P.O. Box 41021, Lubbock, TX 79409, USA
| | - Selim Bozkurt
- School of Engineering, Ulster University, York Street, Belfast BT15 1AP, UK
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Rumi F, Fortunato A, Antonini D, Siviero L, Cicchetti A. Analysis of heterogeneity of the different health technology assessment reports produced on the transcatheter aortic valve implantation in patients with severe aortic valve stenosis at low surgical risk. Front Cardiovasc Med 2023; 10:1204520. [PMID: 37636307 PMCID: PMC10450217 DOI: 10.3389/fcvm.2023.1204520] [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: 05/08/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background Symptomatic severe aortic stenosis is a congenital or acquired aortic valve disease that occurs when the aortic valve of the heart narrows. It represents the most common valvular disease in adults and generally has a degenerative nature. Transcatheter aortic valve implantation (TAVI), due to its non-invasive approach, has become the standard treatment in patients who are ineligible to surgery or at high surgical risk, and it is also increasingly being performed in patients at intermediate to low surgical risk. The aim is to analyze the heterogeneity and explore the limitations of current health technology assessments (HTAs) on TAVI. Methods For the purpose of this analysis, a review of the literature based on manual research was performed. A population, intervention, comparators, and outcome (PICO) model was used to gather the HTA reports assessing TAVI in the treatment of patients affected by symptomatic severe aortic valve stenosis at low surgical risk. Furthermore, a manual search has been developed to also include assessments from the Haute Autorité de Santé. Results At the end of the investigation, a certain degree of heterogeneity in the evidence factored and in the recommendations on the technology has emerged. Relative to the clinical domains, the main drivers for the disparity are found in the type of evidence considered and in the use or not of the grading of recommendations, assessment, development, and evaluation (GRADE) methodology to evaluate the quality of the clinical evidence included. Another element concerns the chosen device generation assessed within the evaluation. In order to perform the economic evaluation, a cost-utility analysis and a budget impact model were developed. Despite some elements of heterogeneity, the economic assessments demonstrate a favorable or dominant cost-effectiveness profile for TAVI compared with surgical aortic valve replacement (SAVR). Conclusion Despite the presence of heterogeneity elements both in clinical and economic domains, HTA agencies reached the same recommendations on the use of TAVI. It emerged the need for a centralized vision on the "strong" domains, which means giving up freedom to local bodies to adapt to their context on the "soft" ones. This approach could have the potential to strengthen the role of HTA in Europe by ensuring faster decision-making and equity of access to health innovations and reduce the heterogeneity in the assessment methods.
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Affiliation(s)
- Filippo Rumi
- Alta Scuola di Economia e Management dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Rome,Italy
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Hulstaert F, Pouppez C, Primus-de Jong C, Harkin K, Neyt M. Gaps in the evidence underpinning high-risk medical devices in Europe at market entry, and potential solutions. Orphanet J Rare Dis 2023; 18:212. [PMID: 37491269 PMCID: PMC10369713 DOI: 10.1186/s13023-023-02801-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/05/2023] [Indexed: 07/27/2023] Open
Abstract
AIM To determine the level of evidence for innovative high-risk medical devices at market entry. METHODS We reviewed all Belgian healthcare payer (RIZIV-INAMI) assessor reports on novel implants or invasive medical devices (n = 18, Class IIb-III) available between 2018 to mid-2019 on applications submitted for inclusion on their reimbursement list. We also conducted a review of the literature on evidence gaps and an analysis of relevant legal and ethical frameworks within the European context. FINDINGS Conformity assessment of medical devices is based on performance, safety, and an acceptable risk-benefit balance. Information submitted for obtaining CE marking is confidential and legally protected, limiting access to clinical evidence. Seven out of the 18 RIZIV-INAMI assessor reports (39%) included a randomized controlled trial (RCT) using the novel device, whilst 2 applications (11%) referred to an RCT that used a different device. The population included was inappropriate or unclear for 3 devices (17%). Only half of the applications presented evidence on quality of life or functioning and 2 (11%) presented overall survival data. Four applications (22%) included no data beyond twelve months. The findings from the literature demonstrated similar problems with the study design and the clinical evidence. DISCUSSION AND CONCLUSIONS CE marking does not indicate that a device is effective, only that it complies with the law. The lack of transparency hampers evidence-based decision making. Despite greater emphasis on clinical benefit for the patient, the provisions of the European Medical Device Regulation (MDR) are not yet fully aligned with international ethical standards for clinical research. The MDR fails to address key issues, such as the lack of access to data submitted for CE marking and a failure to require evidence of clinical effectiveness. Indeed, a first report shows no improvement in the clinical evidence for implantable devices generated under the MDR. Thus, patients may continue to be exposed to ineffective or unsafe novel devices. The Health Technology Assessment Regulation plans for Joint Scientific Consultations for specific high-risk devices before companies begin their pivotal clinical investigations. The demanded comparative evidence should facilitate payer decisions. Nevertheless, there is also a need for legislation requiring comparative RCTs assessing patient-relevant outcomes for high-risk devices to ensure implementation, including development and implementation of common specifications for study designs.
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Affiliation(s)
- Frank Hulstaert
- Administrative Centre Botanique, Belgian Health Care Knowledge Centre (KCE), Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, Brussels, B-1000, Belgium.
| | - Céline Pouppez
- Administrative Centre Botanique, Belgian Health Care Knowledge Centre (KCE), Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, Brussels, B-1000, Belgium
| | - Célia Primus-de Jong
- Administrative Centre Botanique, Belgian Health Care Knowledge Centre (KCE), Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, Brussels, B-1000, Belgium
| | - Kathleen Harkin
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Room 0.18, Dublin, Ireland
| | - Mattias Neyt
- Administrative Centre Botanique, Belgian Health Care Knowledge Centre (KCE), Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, Brussels, B-1000, Belgium
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Freitas L, Vieira ACL, Oliveira MD, Monteiro H, Bana E Costa CA. Which value aspects are relevant for the evaluation of medical devices? Exploring stakeholders' views through a Web-Delphi process. BMC Health Serv Res 2023; 23:593. [PMID: 37291513 DOI: 10.1186/s12913-023-09550-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/15/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Implementation and uptake of health technology assessment for evaluating medical devices require including aspects that different stakeholders consider relevant, beyond cost and effectiveness. However, the involvement of stakeholders in sharing their views still needs to be improved. OBJECTIVE This article explores the relevance of distinct value aspects for evaluating different types of medical devices according to stakeholders' views. METHODS Thirty-four value aspects collected through literature review and expert validation were the input for a 2-round Web-Delphi process. In the Web-Delphi, a panel of participants from five stakeholders' groups (healthcare professionals, buyers and policymakers, academics, industry, and patients and citizens) judged the relevance of each aspect, by assigning a relevance-level ('Critical', 'Fundamental', 'Complementary', or 'Irrelevant'), for two types of medical devices separately: 'Implantable' and 'In vitro tests based on biomarkers'. Opinions were analysed at the panel and group level, and similarities across devices were identified. RESULTS One hundred thirty-four participants completed the process. No aspects were considered 'Irrelevant', neither for the panel nor for stakeholder groups, in both types of devices. The panel considered effectiveness and safety-related aspects 'Critical' (e.g., 'Adverse events for the patient'), and costs-related aspects 'Fundamental' (e.g., 'Cost of the medical device'). Several additional aspects not included in existing frameworks' literature, e.g., related to environmental impact and devices' usage by the healthcare professional, were deemed as relevant by the panel. A moderate to substantial agreement across and within groups was observed. CONCLUSION Different stakeholders agree on the relevance of including multiple aspects in medical devices' evaluation. This study produces key information to inform the development of frameworks for valuing medical devices, and to guide evidence collection.
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Grants
- PTDC/EGE-OGE/29699/2017 FCT - Foundation for Science and Technology, I.P. - MEDI-VALUE project (Developing HTA tools to consensualise MEDIcal devices' VALUE through multicriteria decision analysis)
- PTDC/EGE-OGE/29699/2017 FCT - Foundation for Science and Technology, I.P. - MEDI-VALUE project (Developing HTA tools to consensualise MEDIcal devices' VALUE through multicriteria decision analysis)
- PTDC/EGE-OGE/29699/2017 FCT - Foundation for Science and Technology, I.P. - MEDI-VALUE project (Developing HTA tools to consensualise MEDIcal devices' VALUE through multicriteria decision analysis)
- PTDC/EGE-OGE/29699/2017 FCT - Foundation for Science and Technology, I.P. - MEDI-VALUE project (Developing HTA tools to consensualise MEDIcal devices' VALUE through multicriteria decision analysis)
- PTDC/EGE-OGE/29699/2017 FCT - Foundation for Science and Technology, I.P. - MEDI-VALUE project (Developing HTA tools to consensualise MEDIcal devices' VALUE through multicriteria decision analysis)
- UIDB/00097/2020 FCT - Foundation for Science and Technology, I.P. - CEG-IST
- UIDB/00097/2020 FCT - Foundation for Science and Technology, I.P. - CEG-IST
- UIDB/00097/2020 FCT - Foundation for Science and Technology, I.P. - CEG-IST
- UIDB/00097/2020 FCT - Foundation for Science and Technology, I.P. - CEG-IST
- 2020.05289.BD FCT - Foundation for Science and Technology, I.P. - Individual Doctoral Fellowship
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Affiliation(s)
- Liliana Freitas
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisbon, Portugal.
| | - Ana C L Vieira
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisbon, Portugal
| | - Mónica D Oliveira
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisbon, Portugal
- iBB- Institute for Bioengineering and Biosciences and i4HB- Associate Laboratory Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1, Lisbon, 1049-001, Portugal
| | | | - Carlos A Bana E Costa
- CEG-IST, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001, Lisbon, Portugal
- LSE Health-Medical Technology Research Group (MTRG), London School of Economics, Houghton St, London, WC2A 2AE, UK
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Seo G, Park S, Lee M. How to calculate the life cycle of high-risk medical devices for patient safety. Front Public Health 2022; 10:989320. [PMID: 36187681 PMCID: PMC9515981 DOI: 10.3389/fpubh.2022.989320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023] Open
Abstract
In this study, we analyzed Korean and foreign systems, focusing on high-risk medical devices that urgently need to be managed, and we present an life cycle calculation method for determining replacement time. A literature review was conducted to confirm the regulations of the medical device management system and life cycle by country, and a case analysis was performed to verify the replacement evaluation criteria of actual medical institutions. In addition, durability data from the Public Procurement Service, American Hospital Association, and Samsung Medical Center were used to calculate the life cycle of high-risk medical devices. The analysis showed that in the case of Korean and foreign medical device regulatory agencies, there were no specific life cycle regulations for high-risk medical devices. In addition, the important items in the medical device replacement evaluation were found to be the year of introduction, repair cost, component discontinuation, and several failures. On calculating the life cycle of high-risk medical devices revealed that the replacement time is 13 years for anesthesia machines, 14 years for defibrillators, 16 years for heart-lung machines, and 13 years for ventilators. To introduce a uniform medical device replacement standard and life cycle calculation method, the government will need to reorganize the medical device replacement laws and systems. In addition, in the case of medical institutions, it is necessary to secure patient safety by using expert groups to prepare specific life cycle standards that consider the characteristics of medical devices.
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Affiliation(s)
- Gihong Seo
- Medical device & Healthcare Solution (MEDIPLY), Seoul, South Korea
| | - Sewon Park
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Munjae Lee
- Department of Medical Humanities and Social Medicine, Ajou University School of Medicine, Suwon, South Korea,Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, South Korea,*Correspondence: Munjae Lee
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Tarricone R, Petracca F, Cucciniello M, Ciani O. Recommendations for developing a lifecycle, multidimensional assessment framework for mobile medical apps. HEALTH ECONOMICS 2022; 31 Suppl 1:73-97. [PMID: 35388585 PMCID: PMC9545972 DOI: 10.1002/hec.4505] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Digital health and mobile medical apps (MMAs) have shown great promise in transforming health care, but their adoption in clinical care has been unsatisfactory, and regulatory guidance and coverage decisions have been lacking or incomplete. A multidimensional assessment framework for regulatory, policymaking, health technology assessment, and coverage purposes based on the MMA lifecycle is needed. A targeted review of relevant policy documents from international sources was conducted to map current MMA assessment frameworks, to formulate 10 recommendations, subsequently shared amongst an expert panel of key stakeholders. Recommendations go beyond economic dimensions such as cost and economic evaluation and also include MMA development and update, classification and evidentiary requirements, performance and maintenance monitoring, usability testing, clinical evidence requirements, safety and security, equity considerations, organizational assessment, and additional outcome domains (patient empowerment and environmental impact). The COVID-19 pandemic greatly expanded the use of MMAs, but temporary policies governing their use and oversight need consolidation through well-developed frameworks to support decision-makers, producers and introduction into clinical care processes, especially in light of the strong international, cross-border character of MMAs, the new EU medical device and health technology assessment regulations, and the Next Generation EU funding earmarked for health digitalization.
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Affiliation(s)
- Rosanna Tarricone
- Centre for Research in Health and Social Care Management (CERGAS)Government, Health and Non Profit DivisionSDA BocconiMilanItaly
- Department of Social and Political SciencesBocconi UniversityMilanItaly
| | - Francesco Petracca
- Centre for Research in Health and Social Care Management (CERGAS)Government, Health and Non Profit DivisionSDA BocconiMilanItaly
| | - Maria Cucciniello
- Department of Social and Political SciencesBocconi UniversityMilanItaly
- University of Edinburgh Business SchoolScotlandUK
| | - Oriana Ciani
- Centre for Research in Health and Social Care Management (CERGAS)Government, Health and Non Profit DivisionSDA BocconiMilanItaly
- Institute of Health ResearchUniversity of Exeter Medical SchoolExeterUK
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Torbica A, Tarricone R, Schreyögg J, Drummond M. Pushing the boundaries of evaluation, diffusion, and use of medical devices in Europe: Insights from the COMED project. HEALTH ECONOMICS 2022; 31 Suppl 1:1-9. [PMID: 36068719 DOI: 10.1002/hec.4600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
The field of medical devices has attracted considerable interest from scholarly research in health economics in recent years. Medical devices are indispensable tools for quality health care delivery, but their assessment and appropriate use pose significant challenges to healthcare systems. More research is needed to overcome existing gaps associated with evaluation of digital technologies, address challenges in the use of real-world data in generating evidence for decision-making and to uncover drivers of variation in access to medical devices across countries. Furthermore, the translation of the results and recommendations stemming from research projects into health technology assessment practices needs to be strengthened. The European Union (EU) project COMED aimed to address these gaps by improving existing research and developing new research streams on the methods for evaluation and diffusion of medical devices. The project also intended to provide directly applicable policy advice and tools to inform decision-making, with the aim of impacting public health in the EU. This Health Economics Supplement, together with references of other published outputs of the project, is intended to be the main source for researchers and policy makers seeking information on the COMED project.
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Affiliation(s)
- Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milano, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milano, Italy
| | - Jonas Schreyögg
- Hamburg Centre for Health Economics, University of Hamburg, Hamburg, Germany
| | - Mike Drummond
- Centre for Health Economics, University of York, York, UK
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Federici C, Pecchia L. Exploring the misalignment on the value of further research between payers and manufacturers. A case study on a novel total artificial heart. HEALTH ECONOMICS 2022; 31 Suppl 1:98-115. [PMID: 35460307 PMCID: PMC9546170 DOI: 10.1002/hec.4520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/09/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
Payers and manufacturers can disagree on the appropriate level of evidence that is required for new medical devices, resulting in high societal costs due to decisions taken with sub-optimal information. A cost-effectiveness model of a hypothetical total artificial heart was built using data from the literature and the (simulated) results of a pivotal study. The expected value of perfect information (EVPI) was calculated from both the payer and manufacturer perspectives, using net monetary benefit and the company's return on investment respectively. A function was also defined, linking effectiveness to market shares. Additional constraints such as a minimum clinical difference or maximum budget impact were introduced into the company's decisions to simulate additional barriers to adoption. The difference in the EVPI between manufacturers and payers varied greatly depending on the underlying decision rules and constraints. The manufacturer's EVPI depends on the probability of being reimbursed, the uncertainty on the (cost-)effectiveness of the technology, as well as other parameters relating to initial investments, operating costs and market dynamics. The use of Value of information for both perspectives can outline potential misalignments and can be particularly useful to inform early dialogs between manufacturers and payers, or negotiations on conditional reimbursement schemes.
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Affiliation(s)
- Carlo Federici
- SDA Bocconi School of ManagementCentre for Research on Health and Social Care Management (CERGAS)MilanItaly
- School of EngineeringUniversity of WarwickCoventryUK
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Garzotto F, Comoretto RI, Dorigo L, Gregori D, Zotti A, Gaudenzio M, Gerosa G, Bonin M. Preparing healthcare, academic institutions and notified bodies for their involvement in the innovation of medical devices under the new European regulation. Expert Rev Med Devices 2022; 19:613-621. [PMID: 36039712 DOI: 10.1080/17434440.2022.2118046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Favouring innovation by making timely medical technology available to people and by securing patients' safety is a challenge. AREAS COVERED The new European medical device regulation (MDR) will have a central implication in the development of new devices and could affect their innovation and availability, as well as discourage investment in research within Europe. EXPERT OPINION Start-ups and small companies might not be able to cope with the increasing complexity and the required changes of perspective. Healthcare institutions are facing an increasing availability of complex technologies, while data on their clinical efficacy and cost-effectiveness are rarely provided. A partnership/collaboration between healthcare institutions, academia and private industries will enhance their own specific interests with the common goal of improving overall health and quality of life. The complexity of the subject combined with the variety of specialists and stakeholders involved requires the implementation, in hospital centres of clinical excellence, of units dedicated to the whole path of the medical device innovation. Stakeholders should quickly provide adequate measures to facilitate the complex medical device innovation path under the more stringent MDR aimed to increase safety and quality of care.
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Affiliation(s)
- Francesco Garzotto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy.,ASL VCO, Piedmont Region, Italy.,Azienda Zero, Healthcare - Veneto Region, Italy
| | - Rosanna Irene Comoretto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy.,Department of Public Health and Pediatrics, University of Turin, Italy
| | | | - Dario Gregori
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Alessandro Zotti
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Meneghesso Gaudenzio
- Department of Information Engineering, University of Padova, Padova, 35131 Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of Padua , Padua, Italy
| | - Mauro Bonin
- Department of Health Instrumental Resources, Veneto Region, Italy
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Callea G, Federici C, Freddi R, Tarricone R. Recommendations for the design and implementation of an Early Feasibility Studies program for medical devices in the European Union. Expert Rev Med Devices 2022; 19:315-325. [PMID: 35579009 DOI: 10.1080/17434440.2022.2075729] [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: 11/04/2022]
Abstract
INTRODUCTION Early Feasibility Studies (EFS) are among the pre-market clinical investigations allowed by the International Standard for Clinical investigation of medical devices (MD) for human subjects. The Food and Drug Administration (FDA) introduced an EFS program in the US in 2013. The European Union (EU) MD Regulation, that entered into force in May 2021, opened the possibility of EFS in the EU. However, European countries at present have no standardized procedural framework for EFS. In this paper, we address the desirability of a European EFS program. AREAS COVERED Characteristics of EFS conducted so far are reviewed, and perceptions of an expert, multidisciplinary panel of key stakeholders are explored regarding desirability and feasibility of a European EFS program and critical factors favoring or hampering its implementation. EXPERT OPINION Implementing an EFS program in the EU would contribute to creating a favorable environment for early-stage clinical investigations, with positive effects on the quality and timeliness of clinical evidence for novel MDs, and attractiveness of the European system for pre- and post-market clinical research. Based on discussion with experts, also leveraging on the US experience, three dimensions should be considered for effective design and implementation: process, resources, and ethical issues.
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Affiliation(s)
- Giuditta Callea
- Centre for Research on Health and Social Care, SDA Bocconi School of Management, Italy
| | - Carlo Federici
- Centre for Research on Health and Social Care, SDA Bocconi School of Management, Italy
| | - Rachele Freddi
- Centre for Research on Health and Social Care, SDA Bocconi School of Management, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care, SDA Bocconi School of Management, Italy.,Department of Social and Political Science, Bocconi University, Milan, Italy
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Tarricone R, Amatucci F, Armeni P, Banks H, Borsoi L, Callea G, Ciani O, Costa F, Federici C, Torbica A, Marletta M. Establishing a national HTA program for medical devices in Italy: Overhauling a fragmented system to ensure value and equal access to new medical technologies. Health Policy 2021; 125:602-608. [PMID: 33820679 DOI: 10.1016/j.healthpol.2021.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/10/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Differing contexts have greatly influenced HTA development in various countries, with considerable effort recently made by international HTA networks (e.g., EUnetHTA) and the European Union (EU) to make HTA a more coherent, equal, and efficient process. Medical devices (MDs) present particular challenges for HTA because of frequent, rapid innovation, outcomes influenced by end-user competence, dynamic pricing and often low-quality scientific evidence. Our objective is to describe the development, structure and governance of a National HTA Program for MDs (PNHTADM) in Italy, a highly participatory, stakeholder-engaged, evidence-based process to reform a fragmented system of appraisal and approval. Based largely on EUnetHTA methods, the resulting process delineates a standardized system for proposing MDs by any stakeholders, accrediting HTA producers, setting criteria for prioritization and appraisals, and innovatively linking recommendations with coverage, reimbursement and procurement of MDs. Expected benefits include reduced disparities in pricing and reimbursement policies and improved access to new technologies across 21 regional healthcare systems in Italy's decentralized, universal system, complete with provisions to require additional evidence collection and centrally monitor diffusion. Though devised for Italy, the design, resources and underlying analysis provide a framework for other nations seeking to consolidate HTA initiatives, particularly in light of new EU regulation.
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Affiliation(s)
- Rosanna Tarricone
- Department of Social and Political Science, Bocconi University, Via Roentgen 1, 20136 Milan (Italy); Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136 Milan (Italy).
| | - Fabio Amatucci
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136 Milan (Italy)
| | - Patrizio Armeni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136 Milan (Italy)
| | - Helen Banks
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136 Milan (Italy)
| | - Ludovica Borsoi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136 Milan (Italy)
| | - Giuditta Callea
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136 Milan (Italy)
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136 Milan (Italy)
| | - Francesco Costa
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136 Milan (Italy)
| | - Carlo Federici
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136 Milan (Italy)
| | - Aleksandra Torbica
- Department of Social and Political Science, Bocconi University, Via Roentgen 1, 20136 Milan (Italy); Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20136 Milan (Italy)
| | - Marcella Marletta
- Drugs and Medical Devices, Ministry of Health, Via Ribotta 5, 00144 Rome (Italy)
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Tarricone R, Petracca F, Ciani O, Cucciniello M. Distinguishing features in the assessment of mHealth apps. Expert Rev Pharmacoecon Outcomes Res 2021; 21:521-526. [PMID: 33663324 DOI: 10.1080/14737167.2021.1891883] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: The unparalleled surge in digital health adoption during the COVID-19 pandemic has emphasized the potential of mHealth apps. However, the quality of available evidence is generally low, and regulatory frameworks have focused on apps with medical purposes only, overlooking apps with significant interactions with patients that may require stronger oversight.Areas covered: To support this expanded evidence generation process, we identified the reasons that distinguish mHealth apps compared to medical devices at large and that should differentially feature their assessment. mHealth apps are characterized by the iterative nature of the corresponding interventions, frequent user interactions with a non-linear relationship between technology usage, engagement and outcomes, significant organizational implications, as well as challenges associated with genericization, their broad diagnostic potential, and price setting.Expert Opinion: The renewed reliance experienced during the pandemic and the unprecedented injection of resources through recovery instruments can further boost the development of apps. Only robust evidence of the benefits of mHealth apps will persuade health-care professionals and beneficiaries to systematically deploy them. Regulatory bodies will need to question their current approaches by adopting comprehensive evaluation processes that adequately consider the specific features of mHealth apps.
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Affiliation(s)
- Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy.,Department of Social and Political Sciences, Bocconi University, Milano, Italy
| | - Francesco Petracca
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy.,Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
| | - Maria Cucciniello
- Strategy Department, University of Edinburgh Business School, Edinburgh, Scotland, UK
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