There is sparse evidence in the health research literature to link health technology assessment (HTA) processes and outcomes (at a national, regional, or hospital level) with device purchasing decisions, according to ISPOR — The Professional Society for Health Economics and Outcomes Research. The group published its findings in Value in Health.
“Assessing the value of medical devices is a key element in making adoption and coverage decisions, but there are challenges in applying value frameworks to them,” says author Simon Eggington, MSc, Medtronic International Trading Sarl, Tolochenaz, Switzerland. “Medical devices have unique characteristics, such as frequent device iterations and user learning curves, which make it difficult to generalize outcomes — and therefore value — to the broader patient population.
“Additionally,” he says, “many device types exist, each potentially requiring different assessment criteria, and stakeholders may view the value of any technology differently based on their specific needs. As a result, while there is a vast reservoir of information and guidance on HTA, there remains a knowledge gap as to whether nonpayer, non-HTA stakeholders, such as hospital procurement, use the available HTA reports and conclusions in their assessment of medical devices.”
In an effort to fill this gap, members of the ISPOR Medical Devices and Diagnostics Special Interest Group, in collaboration with the Special Interest Group leadership team, conducted a systematic literature review to identify relevant studies and summarize the current evidence base for the criteria used for procurement of medical devices.
Overall, however, the group found minimal evidence regarding the use of HTA in device purchasing, making it problematic to draw firm conclusions about the impact of HTA on procurement, and what little evidence exists is incomplete, regardless of the level or geography at which the HTA and procurement occurs.
According to ISPOR, the application of HTA (and its impact on treatment decisions) varies widely in different geographies, complicating the process of making generalizations. The use of “mini” or hospital-level HTA appears to be growing, suggesting a shift from “classic” HTA to local evaluations, which aims to directly inform procurement decisions. Nevertheless, most of the hospital-level HTA studies reviewed also drew on national-level HTA and published systematic reviews of evidence to inform their conclusions, indicating a continued need for national or regional assessments.
“Further research is needed to better understand the relationship between HTA and procurement, and to identify strategies to bring the two areas closer together and encourage broader and more systemic evidence-based decision making,” says Eggington.
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