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Svempe L. Exploring Impediments Imposed by the Medical Device Regulation EU 2017/745 on Software as a Medical Device. JMIR Med Inform 2024; 12:e58080. [PMID: 39235850 DOI: 10.2196/58080] [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: 03/05/2024] [Revised: 05/08/2024] [Accepted: 05/25/2024] [Indexed: 09/06/2024] Open
Abstract
In light of rapid technological advancements, the health care sector is undergoing significant transformation with the continuous emergence of novel digital solutions. Consequently, regulatory frameworks must continuously adapt to ensure their main goal to protect patients. In 2017, the new Medical Device Regulation (EU) 2017/745 (MDR) came into force, bringing more complex requirements for development, launch, and postmarket surveillance. However, the updated regulation considerably impacts the manufacturers, especially small- and medium-sized enterprises, and consequently, the accessibility of medical devices in the European Union market, as many manufacturers decide to either discontinue their products, postpone the launch of new innovative solutions, or leave the European Union market in favor of other regions such as the United States. This could lead to reduced health care quality and slower industry innovation efforts. Effective policy calibration and collaborative efforts are essential to mitigate these effects and promote ongoing advancements in health care technologies in the European Union market. This paper is a narrative review with the objective of exploring hindering factors to software as a medical device development, launch, and marketing brought by the new regulation. It exclusively focuses on the factors that engender obstacles. Related regulations, directives, and proposals were discussed for comparison and further analysis.
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Affiliation(s)
- Liga Svempe
- Faculty of Social Sciences, Riga Stradins University, Riga, Latvia
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2
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Balzan P, Tattersall C, Palmer R, Murray M. Mapping the development process of transcutaneous neuromuscular electrical stimulation devices for neurorehabilitation, the associated barriers and facilitators, and its applicability to acquired dysarthria: a qualitative study of manufacturers' perspectives. Disabil Rehabil Assist Technol 2024; 19:1923-1934. [PMID: 37855610 DOI: 10.1080/17483107.2023.2269976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE The fragmented nature of the medical device market limits our understanding of how particular sub-markets navigate the device development process. Despite the widespread use of transcutaneous neuromuscular electrical stimulation (NMES), its use for acquired dysarthria treatment has not been sufficiently explored. This study aims to provide a preliminary understanding of the stages involved in the development of NMES devices designed for neurorehabilitation. It also aims to investigate manufacturers' perceptions concerning factors that facilitate or impede its development and determine its applicability for acquired dysarthria. MATERIALS AND METHODS In-depth semi-structured online interviews were conducted with eight NMES device manufacturers located across Europe, North America and Oceania. The interviews were video-recorded, automatically transcribed, manually reviewed, and analysed using a qualitative content analysis. RESULTS NMES device development for neurorehabilitation involves six complex phases with sequential and overlapping activities. Some emerging concepts were comparable to established medical device models, while others were specific to NMES. Its adaptability to different neurological disorders, the positive academia-industry collaborations, the industry's growth prospects and the promising global efforts for standardised regulations are all key facilitators for its development. However, financial, political, regulatory, and natural constraints emerged as barriers. Indications and challenges for the applicability of NMES for acquired dysarthria treatment were also discussed. CONCLUSION The findings provide a foundation for further investigations on the NMES market sub-sector, particularly in the context of neurorehabilitation. The study also provides insights into the potential adoption of NMES for acquired dysarthria, which can serve as a reference for future research.
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Affiliation(s)
- Pasquale Balzan
- Division of Human Communication Sciences, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Catherine Tattersall
- Division of Human Communication Sciences, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Rebecca Palmer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Murray
- Sheffield Healthcare Gateway, University of Sheffield, Sheffield, UK
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Martina MR, Park C, Alastruey J, Bruno RM, Climie R, Dogan S, Tuna BG, Jerončić A, Manouchehri M, Panayiotou AG, Tamarri S, Terentes-Printzios D, Testa M, Triantafyllou A, Mayer CC, Bianchini E. Medical device regulation in vascular ageing assessment: a VascAgeNet survey exploring knowledge and perception. Expert Rev Med Devices 2024; 21:335-347. [PMID: 38557297 DOI: 10.1080/17434440.2024.2334931] [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: 12/25/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Regulation has a key role for medical devices throughout their lifecycle aiming to guarantee effectiveness and safety for users. Requirements of Regulation (EU) 2017/745 (MDR) have an impact on novel and previously approved systems. Identification of key stakeholders' needs can support effective implementation of MDR improving the translation to clinical practice of vascular ageing assessment. The aim of this work is to explore knowledge and perception of medical device regulatory framework in vascular ageing field. RESEARCH DESIGN AND METHODS A survey was developed within VascAgeNet and distributed in the community by means of the EUSurvey platform. RESULTS Results were derived from 94 participants (27% clinicians, 62% researchers, 11% companies) and evidenced mostly a fair knowledge of MDR (despite self-judged as poor by 51%). Safety (83%), validation (56%), risk management (50%) were considered relevant and associated with the regulatory process. Structured support and regulatory procedures connected with medical devices in daily practice at the institutional level are lacking (only 33% report availability of a regulatory department). CONCLUSIONS Regulation was recognized relevant by the VascAgeNet community and specific support and training in medical device regulatory science was considered important. A direct link with the regulatory sector is not yet easily available.
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Affiliation(s)
| | - Chloe Park
- University College London (UCL), London, UK
| | - Jordi Alastruey
- Department of Biomedical Engineering, King's College London, London, UK
| | - Rosa Maria Bruno
- PARCC (Paris Cardiovascular Research Center, Inserm U970), Université Paris Cité, Inserm, Paris, France
| | - Rachel Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Soner Dogan
- Department of Medical Biology, Yeditepe University, School of Medicine, Istanbul, Turkiye
| | - Bilge Guvenc Tuna
- Department of Biophysics, Yeditepe University, School of Medicine, Istanbul, Turkiye
| | - Ana Jerončić
- Department of Research in Biomedicine and Health & Laboratory of Vascular Aging and Cardiovascular Prevention, University of Split School of Medicine, Split, Croatia
| | | | - Andrie G Panayiotou
- Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | - Dimitrios Terentes-Printzios
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | | | - Areti Triantafyllou
- 3rd Clinic of Internal Medicine, Papageorgiou GH, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christopher C Mayer
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
| | - Elisabetta Bianchini
- Institute of Clinical Physiology - Italian National Research Council (CNR-IFC), Pisa, Italy
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Siontis GCM, Coles B, Häner JD, McGovern L, Bartkowiak J, Coughlan JJ, Spirito A, Galea R, Haeberlin A, Praz F, Tomii D, Melvin T, Frenk A, Byrne RA, Fraser AG, Windecker S. Quality and transparency of evidence for implantable cardiovascular medical devices assessed by the CORE-MD consortium. Eur Heart J 2024; 45:161-177. [PMID: 37638967 DOI: 10.1093/eurheartj/ehad567] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND AND AIMS The European Union Medical Device Regulation 2017/745 challenges key stakeholders to follow transparent and rigorous approaches to the clinical evaluation of medical devices. The purpose of this study is a systematic evaluation of published clinical evidence underlying selected high-risk cardiovascular medical devices before and after market access in the European Union (CE-marking) between 2000 and 2021. METHODS Pre-specified strategies were applied to identify published studies of prospective design evaluating 71 high-risk cardiovascular devices in seven different classes (bioresorbable coronary scaffolds, left atrial appendage occlusion devices, transcatheter aortic valve implantation systems, transcatheter mitral valve repair/replacement systems, surgical aortic and mitral heart valves, leadless pacemakers, subcutaneous implantable cardioverter-defibrillator). The search time span covered 20 years (2000-21). Details of study design, patient population, intervention(s), and primary outcome(s) were summarized and assessed with respect to timing of the corresponding CE-mark approval. RESULTS At least one prospective clinical trial was identified for 70% (50/71) of the pre-specified devices. Overall, 473 reports of 308 prospectively designed studies (enrolling 97 886 individuals) were deemed eligible, including 81% (251/308) prospective non-randomized clinical trials (66 186 individuals) and 19% (57/308) randomized clinical trials (31 700 individuals). Pre-registration of the study protocol was available in 49% (150/308) studies, and 16% (48/308) had a peer-reviewed publicly available protocol. Device-related adverse events were evaluated in 82% (253/308) of studies. An outcome adjudication process was reported in 39% (120/308) of the studies. Sample size was larger for randomized in comparison to non-randomized trials (median of 304 vs. 100 individuals, P < .001). No randomized clinical trial published before CE-mark approval for any of the devices was identified. Non-randomized clinical trials were predominantly published after the corresponding CE-mark approval of the device under evaluation (89%, 224/251). Sample sizes were smaller for studies published before (median of 31 individuals) than after (median of 135 individuals) CE-mark approval (P < .001). Clinical trials with larger sample sizes (>50 individuals) and those with longer recruitment periods were more likely to be published after CE-mark approval, and were more frequent during the period 2016-21. CONCLUSIONS The quantity and quality of publicly available data from prospective clinical investigations across selected categories of cardiovascular devices, before and after CE approval during the period 2000-21, were deemed insufficient. The majority of studies was non-randomized, with increased risk of bias, and performed in small populations without provision of power calculations, and none of the reviewed devices had randomized trial results published prior to CE-mark certification.
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Affiliation(s)
- George C M Siontis
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Bernadette Coles
- Velindre University NHS Trust Library and Knowledge Service, Cardiff, UK
| | - Jonas D Häner
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Laurna McGovern
- Department of Cardiology and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, Dublin, Ireland
| | - Joanna Bartkowiak
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - J J Coughlan
- Department of Cardiology and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Alessandro Spirito
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roberto Galea
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Daijiro Tomii
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Tom Melvin
- School of Medicine, Trinity College Dublin, Ireland
| | - André Frenk
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Robert A Byrne
- Department of Cardiology and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, Dublin, Ireland
| | - Alan G Fraser
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
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McDermott O, Kearney B. The value of using real-world evidence as a source of clinical evidence in the European medical device regulations: a mixed methods study. Expert Rev Med Devices 2024; 21:149-163. [PMID: 38041629 DOI: 10.1080/17434440.2023.2291454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/25/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES This study investigates the benefits, limitations and awareness of using Real World Evidence and Real World Data for post-market clinical follow-up studies and clinical evaluation reports in the European Medical Device Regulations. METHODOLOGY A mixed methods study was utilized with qualitative interviews and a quantitative survey. RESULTS The findings from the study demonstrate that in the case of the Medical Device Regulations, opportunities exist for manufacturers of legacy devices to conduct Real World Evidence studies to bridge gaps in clinical evidence. The primary value of Real World Evidence lies in its ability to provide an accurate and, therefore, more reliable measure of device safety and performance. As a measure of safety and performance, it supplements clinical evidence generated from pre and post-market clinical investigations, reducing the costs associated with these studies and supporting the manufacturer's benefit: risk conclusion. CONCLUSION This study provides insight into how the medical device industry could utilize Real World Evidence and have an initiative in the EU similar to the FDA-sponsored NESTcc partnership. This would aid medical device manufacturers in transitioning to the MDR clinical evaluation requirements and mitigate the impact on medical device availability in the EU.
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Affiliation(s)
- Olivia McDermott
- College of Science & Engineering, University of Galway, Galway, Ireland
| | - Breda Kearney
- College of Science & Engineering, University of Galway, Galway, Ireland
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Bretthauer M, Gerke S, Hassan C, Ahmad OF, Mori Y. The New European Medical Device Regulation: Balancing Innovation and Patient Safety. Ann Intern Med 2023. [PMID: 37068279 DOI: 10.7326/m23-0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
The European Union has introduced stricter provisions for medical devices under the new Medical Device Regulation (MDR). The MDR increases requirements for clinical trial testing for many devices before they can legally be placed on the market and extends requirements for rigorous clinical surveillance of benefits and harms to the entire life cycle of devices. New "expert panels" have been established by the European Commission to advise in the assessment of devices toward certification, and the role of previous "notified bodies" (private companies charged by the Commission with ensuring that manufacturers follow the requirements for device testing) is being expanded. The MDR does not contain a grandfathering clause; thus, all existing medical devices must be recertified under the stricter regulation. The recertification deadline has recently been extended to 2027 or 2028, depending on the device's risk class. Whether most device manufacturers can meet these new requirements is uncertain, and the MDR will likely have important consequences for manufacturers, researchers, clinicians, and patients. Enhanced collaborations between the medical device industry and physician partners will be needed to meet the new requirements in a timely manner to avoid shortages of existing devices and to mitigate barriers to development of new devices.
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Affiliation(s)
- Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo, and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway, and Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway (M.B.)
| | - Sara Gerke
- Penn State Dickinson Law, Carlisle, Pennsylvania (S.G.)
| | - Cesare Hassan
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy, and Humanitas Clinical and Research Center-IRCCS, Endoscopy Unit, Rozzano, Italy (C.H.)
| | - Omer F Ahmad
- Wellcome/EPSRC Centre for Interventional & Surgical Sciences, University College London, London, United Kingdom (O.F.A.)
| | - Yuichi Mori
- Clinical Effectiveness Research Group, University of Oslo, and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway, and Showa University Northern Yokohama Hospital, Digestive Disease Center, Yokohama, Japan (Y.M.)
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Albisinni S, Rassweiler J, van Poppel H. The Future of Medical Devices in Europe Is at Stake: Concerns over the Implementation of the Medical Devices Regulation 2017/745. Eur Urol 2023; 83:191-192. [PMID: 36609009 DOI: 10.1016/j.eururo.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
In May 2024, all medical devices in Europe will require to comply with the new Medical Device Regulation 2017/745, including those we have been using for years. Currently, there are major delays and problems associated with this new certification. As clinicians, we express our serious concerns regarding whether the system will be ready on time to ensure that all the medical devices that we use will be available for patient care.
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Affiliation(s)
- Simone Albisinni
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy.
| | | | - Hendrik van Poppel
- Urology, KU Leuven, Leuven, Belgium; EAU Policy Office, Arnhem, The Netherlands
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