3 research outputs found
How innovation can be defined, evaluated and rewarded in health technology assessment
This study has received support from researchproject PID2019.105597RA.I00 financed by the Spanish Ministry of Science and Innovation/National Research Agency MCIN/AEI/10.13039/501100011033. The funders had no role in the study.Background: What constitutes innovation in health technologies can be defined and measured in a number of
ways and it has been widely researched and published about. However, while many countries mention it as a
criterion for pricing or reimbursement of health technologies, countries differ widely in how they define and
operationalise it.
Methods: We performed a literature review, using a snowballing search. In this paper, we explore how innovation
has been defined in the literature in relation to health technology assessment. We also describe how a selection of
countries (England, France, Italy, Spain and Japan) take account of innovation in their health technology assessment
frameworks and explore the key methodologies that can capture it as a dimension of value in a new health
technology. We propose a way of coming to, and incorporating into health technology assessment systems, a
definition of innovation for health technologies that is independent of other dimensions of value that they already
account for in their systems, such as clinical benefit. We use Spain as an illustrative example of how innovation
might be operationalised as a criterion for decision making in health technology assessment.
Results: The countries analysed here can be divided into 2 groups with respect to how they define innovation.
France, Japan and Italy use features such as severity, unmet need and therapeutic added value as indicators of the
degree of innovation of a health technology, while England, Spain consider the degree of innovation as a separate
and additional criterion from others. In the case of Spain, a notion of innovation might be constructed around
concepts of `step-change’, `convenience’, `strength of evidence base’ and `impact on future research &
development’.
Conclusions: If innovation is to be used as operational criteria for adoption, pricing and reimbursement of health
technologies, the concept must be clearly defined, and it ought to be independent from other value dimensions
already captured in their health technology assessment systems.Spanish Ministry of Science and Innovation/National Research Agency PID2019.105597RA.I00MCIN/AEI/10.13039/50110001103
Improved clinical investigation and evaluation of high-risk medical devices: the rationale and objectives of CORE-MD (Coordinating Research and Evidence for Medical Devices)
: In the European Union (EU) the delivery of health services is a national responsibility but there are concerted actions between member states to protect public health. Approval of pharmaceutical products is the responsibility of the European Medicines Agency, whereas authorizing the placing on the market of medical devices is decentralized to independent 'conformity assessment' organizations called notified bodies. The first legal basis for an EU system of evaluating medical devices and approving their market access was the medical device directives, from the 1990s. Uncertainties about clinical evidence requirements, among other reasons, led to the EU Medical Device Regulation (2017/745) that has applied since May 2021. It provides general principles for clinical investigations but few methodological details-which challenges responsible authorities to set appropriate balances between regulation and innovation, pre- and post-market studies, and clinical trials and real-world evidence. Scientific experts should advise on methods and standards for assessing and approving new high-risk devices, and safety, efficacy, and transparency of evidence should be paramount. The European Commission recently awarded a Horizon 2020 grant to a consortium led by the European Society of Cardiology and the European Federation of National Associations of Orthopaedics and Traumatology, that will review methodologies of clinical investigations, advise on study designs, and develop recommendations for aggregating clinical data from registries and other real-world sources. The CORE-MD project (Coordinating Research and Evidence for Medical Devices) will run until March 2024; here we describe how it may contribute to the development of regulatory science in Europe