Improving the methods for the economic evaluation of medical devices

Medical devices (MDs) have distinctive features, such as incremental innovation, dynamic pricing, the learning curve and organizational 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 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 (HTA) 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, organizational 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 reducing uncertainties and make policy-makers more confident to achieve conclusive recommendations.