title: Linking the Regulatory and Reimbursement Processes for Medical Devices: The Need for Integrated Assessments.
abstract: Much criticism has been directed at the licencing requirements for medical devices (MDs) as they often result in a lack of robust evidence to inform health technology assessment (HTA) decisions. To better understand the current international decisional framework on MD technologies, we undertook three linked research studies: a review of the device regulatory procedures, a survey of current HTA practices and an empirical comparison of HTA reports of drugs versus MDs. Our review confirms that current device regulatory processes across the globe are substantially less stringent than drugs. As a result, international HTA agencies report that they face a number of challenges when assessing MDs, including reliance on suboptimal data to make clinical and cost-effectiveness decisions. Whilst many HTA agencies have adapted their processes and procedures to handle MD technology submissions, in our comparison of HTA reports we found little evidence of the application of methodologies that take account of device-specific issues, such as incremental development. Overall, our research reinforces the need for better linkage between licencing and HTA and the development and application of innovative HTA methodologies with the objective of securing faster patient access for those technologies that can be shown to represent good value for money. © 2017 The Authors. Health Economics Published by John Wiley & Sons, Ltd.
authors.affiliation: Evidence Synthesis and Modelling for Health Improvement, Institute of Health Research, University of Exeter Medical School, Exeter, UK.|Centre for Research on Health and Social Care Management, Università Bocconi, Milan, Italy.
authors.forename: Oriana
authors.initials: O
authors.lastname: Ciani
authors.affiliation: Evidence Synthesis and Modelling for Health Improvement, Institute of Health Research, University of Exeter Medical School, Exeter, UK.
authors.forename: Britni
authors.initials: B
authors.lastname: Wilcher
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Anoukh
authors.initials: A
authors.lastname: van Giessen
authors.affiliation: Evidence Synthesis and Modelling for Health Improvement, Institute of Health Research, University of Exeter Medical School, Exeter, UK.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
mesh_terms: D000072038:Cardiac Rehabilitation / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D002318:Cardiovascular Diseases / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis / Q000379:methods / Q000592:standards*; D004864:Equipment and Supplies / Q000191:economics / Q000592:standards*; D005062:European Union; D006801:Humans; D008004:Licensure / Q000592:standards; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods / Q000592:standards; D010330:Patents as Topic; D012051:Reimbursement Mechanisms / Q000592:standards*; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000379:methods / Q000592:standards*
keywords: health technology assessment; market access; medical device; regulation