Improving the Methods for the Economic Evaluation of Medical Devices

Abstract

Medical devices (MDs) have distinctive features, such as incremental innovation, dynamic pricing, the learning curve and organisational impact, that need to be considered when they are evaluated. This paper investigates how MDs have been assessed in practice, in order to identify methodological gaps that need to be addressed to improve the decision-making process for their adoption.We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist supplemented by some additional categories to assess the quality of reporting and consideration of the distinctive features of MDs. Two case studies were considered: transcatheter aortic valve implantation (TAVI) representing an emerging technology and implantable cardioverter defibrillators (ICDs) representing a mature technology. Economic evaluation studies published as journal articles or within Health Technology Assessment reports were identified through a systematic literature review. A total of 19 studies on TAVI and 41 studies on ICDs were analysed. Learning curve was considered in only 16% of studies on TAVI. Incremental innovation was more frequently mentioned in the studies of ICDs, but its impact was considered in only 34% of the cases. Dynamic pricing was the most recognised feature but was empirically tested in less than half of studies of TAVI and only 32% of studies on ICDs. Finally, organisational impact was considered in only one study of ICDs and in almost all studies on TAVI, but none of them estimated its impact.By their very nature, most of the distinctive features of MDs cannot be fully assessed at market entry. However, their potential impact could be modelled, based on the experience with previous MDs, in order to make a preliminary recommendation. Then, well-designed post-market studies could help in reducing uncertainties and make policymakers more confident to achieve conclusive recommendations.

Vaccines are different: A systematic review of budget impact analyses of vaccines

“…It is also specific to each type of technology. For instance, while medical devices have distinctive features, such as incremental innovation, dynamic pricing, the learning curve and organizational impact [34,35], vaccines are characterized by features such as eligible population, vaccine coverage, herd protection, time horizon, model choice, cost categories (e.g. program implementation and logistics, campaigns).…”

Key Recommendations from the MedtecHTA Project

“…In their paper in this supplement, Tarricone et al (2017) point to the inadequacies in existing economic evaluations and make recommendations for improvements in future studies.…”

Systematische Übersichtsarbeit: Aussagekraft und Übertragbarkeit der Ergebnisse gesundheitsökonomischer Evaluationen zum perkutanen Aortenklappenersatz

“…B. hybrider Operationssaal, Herzteam) und die hohen Kosten der TAVI-Klappen selbst [19]. Die hohen Kosten sowie die Zunahme an durchgeführten TAVIProzeduren haben wesentliche Auswirkungen auf das Gesundheitsbudget.…”

“…Die Daten des österreichischen TAVI-Registers zeigen, dass es von 2011 bis 2015 zu einem Anstieg an TAVI-Prozeduren von zirka 60 % gekommen war [20]. Aus diesem Grund wird Evidenz zur Kosteneffektivität von TAVI vermehrt von den Entscheidungsträgern nachgefragt [19]. Als Entscheidungshilfe können unterschiedliche gesundheitsöko-nomische Modelle herangezogen werden.…”

“…Als Entscheidungshilfe können unterschiedliche gesundheitsöko-nomische Modelle herangezogen werden. In jedem Modell werden die Kosten in Relation zu den jeweiligen Effekten dargestellt, wobei die Effekte je nach Studientyp unterschiedlich bewertet werden [19,21].…”