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Eckhardt H, Felgner S, Dreger M, Fuchs S, Ermann H, Rödiger H, Rombey T, Busse R, Henschke C, Panteli D. Utilization of innovative medical technologies in German inpatient care: does evidence matter? Health Res Policy Syst 2023; 21:100. [PMID: 37784100 PMCID: PMC10546629 DOI: 10.1186/s12961-023-01047-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/26/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The reimbursement of new technologies in inpatient care is not always linked to a requirement for evidence-based evaluation of patient benefit. In Germany, every new technology approved for market was until recently eligible for reimbursement in inpatient care unless explicitly excluded. The aim of this work was (1) to investigate the type of evidence that was available at the time of introduction of 25 innovative technologies and how this evidence evolved over time, and (2) to explore the relationship between clinical evidence and utilization for these technologies in German inpatient care. METHODS This study combined different methods. A systematic search for evidence published between 2003 and 2017 was conducted in four bibliographic databases, clinical trial registries, resources for clinical guidelines, and health technology assessment-databases. Information was also collected on funding mechanisms and safety notices. Utilization was measured by hospital procedures captured in claims data. The body of evidence, funding and safety notices per technology were analyzed descriptively. The relationship between utilization and evidence was explored empirically using a multilevel regression analysis. RESULTS The number of included publications per technology ranges from two to 498. For all technologies, non-comparative studies form the bulk of the evidence. The number of randomized controlled clinical trials per technology ranges from zero to 19. Some technologies were utilized for several years without an adequate evidence base. A relationship between evidence and utilization could be shown for several but not all technologies. CONCLUSIONS This study reveals a mixed picture regarding the evidence available for new technologies, and the relationship between the development of evidence and the use of technologies over time. Although the influence of funding and safety notices requires further investigation, these results re-emphasize the need for strengthening market approval standards and HTA pathways as well as approaches such as coverage with evidence development.
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Affiliation(s)
- Helene Eckhardt
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany.
| | - Susanne Felgner
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Marie Dreger
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Sabine Fuchs
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Hanna Ermann
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Hendrikje Rödiger
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Tanja Rombey
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
- Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
| | - Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany
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Evangelista I, Wencel D, Beguin S, Zhang N, Gilchrist MD. Influence of Surface Texturing on the Dry Tribological Properties of Polymers in Medical Devices. Polymers (Basel) 2023; 15:2858. [PMID: 37447503 DOI: 10.3390/polym15132858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/25/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
There is a constant need to improve patient comfort and product performance associated with the use of medical devices. Efforts to optimise the tribological characteristics of medical devices usually involve modifying existing devices without compromising their main design features and functionality. This article constitutes a state-of-the-art review of the influence of dry friction on polymeric components used in medical devices, including those having microscale surface features. Surface tribology and contact interactions are discussed, along with alternative forms of surface texturing. Evident gaps in the literature, and areas warranting future research are highlighted; these include friction involving polymer Vs polymer surfaces, information regarding which topologies and feature spacings provide the best performing textured surfaces, and design guidelines that would assist manufacturers to minimise or maximise friction under non-lubricated conditions.
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Affiliation(s)
- Isabela Evangelista
- School of Mechanical & Materials Engineering, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
- BD (Becton, Dickinson & Company), Blackrock Business Park, Carysfort Avenue, Blackrock, A94 H2X4 Dublin, Ireland
| | - Dorota Wencel
- BD (Becton, Dickinson & Company), Blackrock Business Park, Carysfort Avenue, Blackrock, A94 H2X4 Dublin, Ireland
| | - Steve Beguin
- BD (Becton, Dickinson & Company), Blackrock Business Park, Carysfort Avenue, Blackrock, A94 H2X4 Dublin, Ireland
| | - Nan Zhang
- School of Mechanical & Materials Engineering, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Michael D Gilchrist
- School of Mechanical & Materials Engineering, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
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Maci J, Marešová P. Critical Factors and Economic Methods for Regulatory Impact Assessment in the Medical Device Industry. Healthc Policy 2022; 15:71-91. [PMID: 35082542 PMCID: PMC8784272 DOI: 10.2147/rmhp.s346928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/30/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Methods Results Discussion
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Affiliation(s)
- Jan Maci
- Department of Economics, Faculty of Informatics and Management, University of Hradec Králové, Hradec Králové, Czech Republic
| | - Petra Marešová
- Department of Economics, Faculty of Informatics and Management, University of Hradec Králové, Hradec Králové, Czech Republic
- Correspondence: Petra Marešová Department of Economics, Faculty of Informatics and Management, University of Hradec Králové, Rokitanskeho 62, Hradec Králové, 50003, Czech RepublicTel +420 737928745 Email
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Dubin JR, Simon SD, Norrell K, Perera J, Gowen J, Cil A. Risk of Recall Among Medical Devices Undergoing US Food and Drug Administration 510(k) Clearance and Premarket Approval, 2008-2017. JAMA Netw Open 2021; 4:e217274. [PMID: 33956132 PMCID: PMC8103223 DOI: 10.1001/jamanetworkopen.2021.7274] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE The US Food and Drug Administration (FDA) uses 510(k) clearance and premarket approval (PMA) pathways to ensure device safety before marketing. Premarket approval evaluates high-risk medical devices and requires clinical trials, whereas 510(k) clearance evaluates moderate-risk devices and relies on benchtop (nonclinical and biomechanical) and descriptive data. Existing literature suggests that the clinical trials required by PMA are associated with reduced risk of recall compared with devices granted 510(k) clearance. Several investigators have found weaknesses in pivotal PMA trials, raising safety concerns. Furthermore, methodological factors may have led to a previous underestimation of recall risk for devices with PMA. OBJECTIVES To compare risk of recall and high-risk recall between devices that received 510(k) clearance and those that received PMA and to compare the risk of recall between devices for medical specialties. DESIGN, SETTING, AND PARTICIPANTS This cohort study compared devices with 510(k) clearance vs those with PMA that reached the market between January 1, 2008, and December 31, 2017. Two- to 12-year follow-up was obtained from the FDA's 510(k) and PMA medical device database. Orthopedic surgery was chosen arbitrarily as the reference category for analysis between specialties because no baseline exists. Statistical analysis was performed from February 1 to November 1, 2020. MAIN OUTCOMES AND MEASURES The FDA issues recalls for safety concerns. These recalls are stratified into class I, II, and III, with class I representing high-risk issues for serious harm or death. The main outcome was the hazard ratio of any recall and class I recall between devices with PMA and those with 510(k) clearance. The secondary outcome was the recall hazard ratio between specialties with respect to the reference category. A single Cox proportional hazards regression model evaluating the association of medical specialty and FDA approval pathway with the risk of recall was performed. RESULTS During the study period, 28 246 devices received 510(k) clearance and 310 devices (10.7%) received PMA; 3012 devices (10.7%) with 510(k) clearance and 84 devices (27.1%) with PMA were recalled. A total of 216 devices (0.8%) with 510(k) clearance and 16 devices (5.2%) with PMA had class I recalls. Devices with PMA compared with those with 510(k) clearance had a hazard ratio for recall of 2.74 (95% CI, 2.19-3.44; P < .001) and a hazard ratio for high-risk recall of 7.30 (95% CI, 4.39-12.13; P < .001). Only radiologic devices were associated with an increased risk of recall (hazard ratio, 1.57; 95% CI, 1.32-1.87; P < .001), whereas 6 specialties were assocated with a decreased risk compared with the orthopedic reference category: general and plastic surgery, otolaryngology, obstetrics and gynecology, physical medicine, hematology, and general hospital. CONCLUSIONS AND RELEVANCE This study suggests that high-risk medical devices approved via PMA are associated with a greater risk of recall than previously reported. Most recalls are for devices with 510(k) clearance, also raising safety concerns. Strengthening postmarketing surveillance strategies and pivotal trials may improve device safety.
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Affiliation(s)
- Jonathan R. Dubin
- Department of Orthopedic Surgery, University of Missouri–Kansas City, Kansas City
- Department of Orthopedic Surgery, Truman Medical Center, Kansas City, Missouri
| | - Stephen D. Simon
- Department of Medical and Health Informatics, University of Missouri–Kansas City, Kansas City
| | - Kirsten Norrell
- Department of Orthopedic Surgery, University of Missouri–Kansas City, Kansas City
- Department of Orthopedic Surgery, Truman Medical Center, Kansas City, Missouri
| | - Jacob Perera
- Department of Orthopedic Surgery, University of Missouri–Kansas City, Kansas City
| | - Jacob Gowen
- Department of Orthopedic Surgery, University of Missouri–Kansas City, Kansas City
| | - Akin Cil
- Department of Orthopedic Surgery, University of Missouri–Kansas City, Kansas City
- Department of Orthopedic Surgery, Truman Medical Center, Kansas City, Missouri
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Okolie O, Stachurek I, Kandasubramanian B, Njuguna J. 3D Printing for Hip Implant Applications: A Review. Polymers (Basel) 2020; 12:E2682. [PMID: 33202958 PMCID: PMC7697992 DOI: 10.3390/polym12112682] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
There is a rising demand for replacement, regeneration of tissues and organ repairs for patients who suffer from diseased/damaged bones or tissues such as hip pains. The hip replacement treatment relies on the implant, which may not always meet the requirements due to mechanical and biocompatibility issues which in turn may aggravate the pain. To surpass these limitations, researchers are investigating the use of scaffolds as another approach for implants. Three-dimensional (3D) printing offers significant potential as an efficient fabrication technique on personalized organs as it is capable of biomimicking the intricate designs found in nature. In this review, the determining factors for hip replacement and the different fabrication techniques such as direct 3D printing, Fused Deposition Modelling (FDM), Selective Laser Sintering (SLS) and stereolithography (SLA) for hip replacement. The study also covers surface modifications of 3D printed implants and provides an overview on 3D tissue regeneration. To appreciate the current conventional hip replacement practices, the conventional metallic and ceramic materials are covered, highlighting their rationale as the material of choice. Next, the challenges, ethics and trends in the implants' 3D printing are covered and conclusions drawn. The outlook and challenges are also presented here. The knowledge from this review indicates that 3D printing has enormous potential for providing a pathway for a sustainable hip replacement.
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Affiliation(s)
- Obinna Okolie
- Centre of Advanced Engineering Materials, School of Engineering, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen AB10 7AQ, UK;
| | - Iwona Stachurek
- Łukasiewicz Research Network—Krakow Institute of Technology, 73 Zakopianska Street, 30-418 Krakow, Poland;
| | - Balasubramanian Kandasubramanian
- Rapid Prototyping Lab, Department of Metallurgical and Materials Engineering, Defence Institute of Advanced Technology (DU), Ministry of Defence, Girinagar, Pune, Maharashtra 411025, India;
| | - James Njuguna
- Centre of Advanced Engineering Materials, School of Engineering, Robert Gordon University, Riverside East, Garthdee Road, Aberdeen AB10 7AQ, UK;
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Medical Device Failure—Implant Retrieval, Evaluation, and Failure Analysis. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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van Susante JLC. The (r)evolution of hyped innovations in orthopedic implants: can prudent introduction avoid throwing the baby out with the bathwater? Acta Orthop 2019; 90:507-510. [PMID: 31550954 PMCID: PMC6844368 DOI: 10.1080/17453674.2019.1669115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Job L C van Susante
- Department of Orthopedics, Rijnstate Ziekenhuis, Arnhem, The Netherlands,Correspondence:
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Harrison-Brown M, Scholes C, Ebrahimi M, Field C, Cordingley R, Kerr D, Farah S, Kohan L. Predicting changes in the status of patient-reported outcome measures after Birmingham Hip Resurfacing: an observational cohort study with a median follow-up of ten years. Bone Joint J 2019; 101-B:1431-1437. [PMID: 31674251 DOI: 10.1302/0301-620x.101b11.bjj-2019-0663.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS It is not known whether change in patient-reported outcome measures (PROMs) over time can be predicted by factors present at surgery, or early follow-up. The aim of this study was to identify factors associated with changes in PROM status between two-year evaluation and medium-term follow-up. PATIENTS AND METHODS Patients undergoing Birmingham Hip Resurfacing completed the Veteran's Rand 36 (VR-36), modified Harris Hip Score (mHHS), Tegner Activity Score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at two years and a minimum of three years. A change in score was assessed against minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds. Binary logistic regression was used to assess the relationship between patient factors and deterioration in PASS status between follow-ups. RESULTS Overall, 18% of patients reported reductions in mHHS total score exceeding MCID, and 21% reported similar reductions for WOMAC function scores. Nonetheless, almost all patients remained above PASS thresholds for WOMAC function (98%) and mHHS (93%). Overall, 66% of patients with mHHS scores < PASS at two years reported scores > PASS at latest follow-up. Conversely, 6% of patients deteriorated from > PASS to < PASS between follow-ups. Multivariable modelling indicated body mass index (BMI) > 27 kg/m2, VR-36 Physical Component Score (PCS) < 51, VR-36 Mental Component Score (MCS) > 55, mHHS < 84 at two years, female sex, and bone graft use predicted these deteriorating patients with 79% accuracy and an area under the curve (AUC) of 0.84. CONCLUSION Due to largely acceptable results at a later follow-up, extensive monitoring of multiple PROMs is not recommended for Birmingham Hip Resurfacing patients unless they report borderline or unacceptable hip function at two years, are female, are overweight, or received a bone graft during surgery. Cite this article: Bone Joint J 2019;101-B:1431-1437.
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Affiliation(s)
| | | | | | - C Field
- Joint Orthopaedic Centre, Sydney, Australia
| | | | - D Kerr
- Joint Orthopaedic Centre, Sydney, Australia
| | - S Farah
- Joint Orthopaedic Centre, Sydney, Australia.,AM Orthopaedics, Sydney, Australia
| | - L Kohan
- Joint Orthopaedic Centre, Sydney, Australia
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Schlauderaff A, Boyer KC. An Overview of Food and Drug Administration Medical Device Legislation and Interplay with Current Medical Practices. Cureus 2019; 11:e4627. [PMID: 31312553 PMCID: PMC6615584 DOI: 10.7759/cureus.4627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Since the emergence of medical devices, legislation has been developed to allow the Federal Drug Administration (FDA) to oversee their development, marketing, and usage. This paper discusses the history of the FDA's involvement in medical devices, current approval processes, and several case examples. Additionally, it discusses both short- and long-term effects with unexpected consequences to U.S. health care delivery.
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Scholes CJ, Ebrahimi M, Farah SB, Field C, Cordingley R, Kerr D, Kohan L. The outcome and survival of metal-on-metal hip resurfacing in patients aged less than 50 years. Bone Joint J 2019; 101-B:113-120. [DOI: 10.1302/0301-620x.101b1.bjj-2018-0702.r1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Aims The aim of this study was to report the implant survival and patient-reported outcome measures (PROMs) in a consecutive series of patients aged less than 50 years at the time of arthroplasty using the Birmingham Hip Resurfacing system (BHR), with a minimum follow-up of ten years. Patients and Methods A total of 226 patients with osteoarthritis of the hip, who underwent BHR and presented to a single surgeon, were included in the study. Survival of the implant was confirmed by cross-checking with the Australian Orthopaedic Association National Joint Replacement Registry. Kaplan–Meier survival curves with 95% confidence intervals (CIs) were constructed. Pre- and postoperative PROMs were compared with t-tests, and postoperative scores were compared using anchor analysis with age and gender matched normative data. Results At median follow-up of 12 years (interquartile range (IQR) 10 to 13), six BHRs were revised, with a cumulative rate of survival of 96.8% (95% confidence interval (CI) 94.2 to 99.4) at 15 years, and with a significantly lower (p = 0.019) cumulative rate of revision than the national average for the same device at ten years. Most revisions (n = 4) were undertaken early, less than three years postoperatively, and occurred in women. Patient-reported general health (Veteran’s Rand-36), disease state (Western Ontario and McMaster Universities Osteoarthritis Index), function (modified Harris Hip Score) and level of activity (Tegner activity score) maintained significant (p < 0.01 for each) improvements beyond ten years postoperatively and were equal to, or exceeded, age- and gender-matched normative data in more than 80% of the patients. Conclusion Longer term PROMs after BHR, from a single surgeon, for patients aged less than 50 years remain under-reported. We found that the outcome after a BHR, at a minimum of ten years postoperatively, remained satisfactory, particularly for self-reported hip function.
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Affiliation(s)
| | | | | | - C. Field
- Joint Orthopaedic Centre, Sydney, Australia
| | | | - D. Kerr
- Joint Orthopaedic Centre, Sydney, Australia
| | - L. Kohan
- Joint Orthopaedic Centre, Sydney, Australia
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Nečas D, Vrbka M, Gallo J, Křupka I, Hartl M. On the observation of lubrication mechanisms within hip joint replacements. Part II: Hard-on-hard bearing pairs. J Mech Behav Biomed Mater 2019; 89:249-259. [DOI: 10.1016/j.jmbbm.2018.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 11/25/2022]
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