Abstract
Randomised Controlled trial evidence of efficacy and safety has long been a requirement for pharmaceuticals to gain market access. In contrast, the evidence requirements for the approval of nondrug technologies, in particular medical devices, have traditionally been much lower. However, with increasing health-care costs and pressure of limited budgets, policy-makers are increasingly turning to health technology assessment (that includes consideration of comparative effectiveness and economic value) to inform their decisions on technology coverage and reimbursement. This chapter describes the differences between medical devices and drugs that impact on the assessment of their comparative clinical and cost-effectiveness.
Most international health technology assessment agencies have a common mandate to evaluate both medical devices and drugs. At this time there appears to be little or no explicit consideration by the health technology assessment community of the potential differences between medical devices and drugs either in their assessment or appraisal processes. Comparing medical devices to drugs highlights the challenges in the common assessment – both comparative effectiveness and economic evaluation – of drug versus nondrug technologies.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ades AE, Sculpher M, et al. Bayesian methods for evidence synthesis in cost-effectiveness analysis. Pharmacoeconomics. 2006;24(1):1–19.
Advamed. The medical technology industry at a glance. 2004. Retrieved Apr 2012 from http://www.lewin.com/~/media/lewin/site_sections/publications/2700.pdf
Boutron I, Moher D, et al. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148(4):295–309.
Challoner DR, Vodra WW. Medical devices and health–creating a new regulatory framework for moderate-risk devices. N Engl J Med. 2011;365(11):977–9.
Ciani O, Wilcher B, Blankart CR, Hatz M, Rupel VP , Erker RS, Varabyova Y, Taylor RS. Health Technology Assessment of medical devices: An international survey of non-European Union HTA agencies. Int J Technol Assess Health Care. 2015;31:154–165.
Cohen D, Billingsley M. Europeans are left to their own devices. BMJ. 2011;342:d2748.
Council Directive 93/42/EEC of 14 June 1993 concerning medical devices. 93/42/EEC. 1993.
Curfman GD, Redberg RF. Medical devices–balancing regulation and innovation. N Engl J Med. 2011;365(11):975–7.
Dhruva SS, Bero LA, et al. Strength of study evidence examined by the FDA in premarket approval of cardiovascular devices. JAMA. 2009;302(24):2679–85.
Drummond M, Griffin A, et al. Economic evaluation for devices and drugs–same or different? Value Health. 2009;12(4):402–4.
Eucomed. The medical technology industry in Europe accessed. 2011. Retrieved Mar 2012 from http://www.eucomed.org/medical-technology
European Commission. Exploring innovative healthcare. The role of medical technology innovation and regulation. 2011.
FDA. Safety background and definitions. 2012. From http://www.fda.gov/safety/recalls/ucm165546.htm
Firth BG, Cooper LM, et al. The appropriate role of cost-effectiveness in determining device coverage: a case study of drug-eluting stents. Health Aff (Millwood). 2008;27(6):1577–86.
International Network of Agencies for Health Technology Assessment (INAHTA). HTA glossary. 2010. Retrieved Nov 2010 from http://www.htaglossary.net/
Jonsson E, Banta D. Treatments that fail to prove their worth. Interview by Judy Jones. BMJ. 1999;319(7220):1293.
Medical Device Amendments of 1976: Pub. L. No. 94-295. 1976.
National Institute for Health and Care Excellence (NICE). Ischaemic heart disease – coronary artery stents (review): appraisal consultation document. 2007. Retrieved Mar 2012 from http://www.nice.org.uk/guidance/index.jsp?action=article%26o=36946
National Institute for Health and Care Excellence (NICE). Drug-eluting stents for the treatment of coronary artery disease. Part review of NICE technology appraisal guidance 71. 2008a. Retrieved Mar 2012 from http://www.nice.org.uk/nicemedia/pdf/TA152Guidance.pdf
National Institute for Health and Clinical Excellence (NICE). Guide to the methods of technology appraisal. 2008b. Retrieved Mar 2012 from http://www.nice.org.uk/media/B52/A7/TAMethodsGuideUpdatedJune2008.pdf
Peinemann F, McGauran N, et al. Disagreement in primary study selection between systematic reviews on negative pressure wound therapy. BMC Med Res Methodol. 2008;8:41.
Ramsay CR, Grant AM, et al. Assessment of the learning curve in health technologies. A systematic review. Int J Technol Assess Health Care. 2000;16(4):1095–108.
Reynolds MR, Magnuson EA, et al. Cost-effectiveness of transcatheter aortic valve replacement compared with standard care among inoperable patients with severe aortic stenosis: results from the placement of aortic transcatheter valves (PARTNER) trial (Cohort B). Circulation. 2012;125(9):1102–9.
Rodes-Cabau J, Webb JG, et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol. 2010;55(11):1080–90.
Sedrakyan A, Marinac-Dabic D, et al. A framework for evidence evaluation and methodological issues in implantable device studies. Med Care. 2010;48 Suppl 6:S121–8.
Sherry KM, McNamara J, et al. An economic evaluation of propofol/fentanyl compared with midazolam/fentanyl on recovery in the ICU following cardiac surgery. Anaesthesia. 1996;51(4):312–7.
Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ. 2003;327(7429):1459–61.
Smith B, Tarricone R, Vella VA et al. The role of product life cycle in medical technology innovation. J Medical Marketing. 2013;13:37–43.
Tarricone R, Drummond M. Challenges in the clinical and economic evaluation of medical devices: the case of transcatheter aortic valve implantation. J Med Market. 2011;11(3):9.
Tarricone R, Aguzzi G, et al. Cost-effectiveness analysis for trigeminal neuralgia: cyberknife vs microvascular decompression. Neuropsychiatr Dis Treat. 2008;4(3):647–52.
Taylor RS, Iglesias CP. Assessing the clinical and cost-effectiveness of medical devices and drugs: are they that different? Value Health. 2009;12(4):404–6.
Taylor RS, Drummond MF, et al. Inclusion of cost effectiveness in licensing requirements of new drugs: the fourth hurdle. BMJ. 2004;329(7472):972–5.
The Lancet. Silicone breast implants: lessons from the USA. Lancet. 2012;379(9811):93.
Thompson M, Heneghan C, et al. Medical device recalls and transparency in the UK. BMJ. 2011;342:d2973.
Vahanian A, Alfieri O, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2008;29(11):1463–70.
Webb JG, Altwegg L, et al. A new transcatheter aortic valve and percutaneous valve delivery system. J Am Coll Cardiol. 2009;53(20):1855–8.
Wendler O, Walther T, et al. Trans-apical aortic valve implantation: univariate and multivariate analyses of the early results from the SOURCE registry. Eur J Cardiothorac Surg. 2010;38(2):119–27.
Wilmshurst P. The regulation of medical devices. BMJ. 2011;342:d2822.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Appendix
Rights and permissions
Copyright information
© 2016 Springer Science+Business Media New York
About this entry
Cite this entry
Ciani, O., Tarricone, R., Taylor, R.S. (2016). Comparing Drug and Nondrug Technologies in Comparative Effectiveness Research. In: Levy, A., Sobolev, B. (eds) Comparative Effectiveness Research in Health Services. Health Services Research. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7600-0_16
Download citation
DOI: https://doi.org/10.1007/978-1-4899-7600-0_16
Published:
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4899-7599-7
Online ISBN: 978-1-4899-7600-0
eBook Packages: MedicineReference Module Medicine