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PubMed2006

[Health economics and HTA].

For a comprehensive health technology assessment (HTA), health economic studies are analysed as well as medical studies. Significance and effects of HTA are rather different in European countries. In Germany HTA is conducted by two official agencies: DIMDI and IQWiG. While DIMDI requires health economic assessments, IQWiG is prohibited from considering economic aspects by law (pure assessment of benefits). For the health economic assessment in HTA reports mainly secondary scientific evidence is exploited, i.e. primarily cost effectiveness and cost utility analyses. The study perspective, the study alternatives and the modelling methods are of great importance for the evaluation and have to be justified in depth. The cost effectiveness ratio and the budget impact are the most important results of the health economic assessment, which is the basis for the appraisal by the health care authorities. For this decision medical, utilitarian or other aspects like the avoidance of unwanted distribution effects are considered. On the other hand often only a few studies are available for the decision making when the appraisal has to be done. This problem might be less relevant in the near future as the number of HTAs and the number of health economic evaluations increases.

Biomedical Technology↗
PubMed2005

Medical technology horizon scanning.

Horizon scanning is becoming particularly important in the medical industry, in the identification and evaluation of emerging technologies. This paper examines the role biomedical engineers may have in horizon scanning new medical technologies and considers whether this is a useful activity for biomedical engineers. A horizon scanning methodology for conducting studies of emerging medical technologies is introduced, consisting of the three main phases of (a) a systematic literature review, in which a set approach is taken to the gathering of information; (b) scanning for publications across a range of different sources; and (c) consideration of the literature in relation to fixed benchmarks to indicate the quality of published information and reported achievements. This methodology has been successfully applied by the authors in a horizon scanning study for the purpose of advising a Government agency on the status of remote patient monitoring technology.

Australia↗
PubMed1999

Coalition building and public opinion. New reproductive technologies and Canadian civil society.

The process of technology assessment is evolving. The process of policy development for technology is the least understood in the cycle of technology assessment. The process of policy development, which should involve extensive consultation and a broad-based research and evaluation program, is often fraught with difficulties and can cause further analysis or the assessment process to come grinding to a halt. This article reviews some social, political, and ethical issues and the role of civil society in influencing the technology assessment process for new reproductive technologies in Canada. It is written from the perspective of one of the Deputy Directors of Research and Evaluation for the Royal Commission on New Reproductive Technologies and highlights the strengths and difficulties of technology assessment when civil society and technology assessment come face to face. A brief update by a policy analyst in Health Canada on the current situation of legislation on new reproductive technologies has been provided and is included at the end of this article.

Advisory Committees↗
PubMed2006

To use technology better.

Although technological innovation can improve health outcomes, the precise magnitude of the contribution and its value are not easily measured. The findings reported by Jonathan Skinner and colleagues temper the favorable conclusions reached by observing correlations between improvement in heart attack outcomes over time with spending on medical products and services. Improvements in health care depend not only on producing better technologies, but also on using technology better.

Acute Disease↗
PubMed2003

Year-end perspectives: the introduction of new technologies.

The regulatory process for medical devices works well for products that involve incremental change to conventional technologies. The situation is not so clear when radically new technologies are introduced into clinical practice. This article discusses some of the issues that are involved and proposes some new solutions.

Biomedical Technology↗
PubMed2006

Magnetic resonance imaging systems: evaluation of 1.5-Tesla systems.

Magnetic resonance imaging (MRI) systems manipulate magnetic fields and radio-frequency signals to create diagnostic images of human anatomy. An MR system is an essential clinical tool, but the cost of buying and installing one is high, so it's crucial that hospitals choose a model carefully. The selection process is made more complex by the numerous options available: different field strengths, gradient systems, coils, and channels, to name just a few. Also, some systems are better than others at facilitating specialized imaging, such as breast and cardiac studies. Our Evaluation is intended to help clarify the choices. We tested three 1.5-tesla systems from three suppliers--GE, Siemens, and Toshiba. We rate the systems for two different uses: inpatient imaging (performed in hospitals) and outpatient imaging (most often performed in imaging centers). For inpatient facilities, which are likely to have less responsive patients and to treat more complex medical problems, the most important purchase considerations will be patient positioning features, advanced imaging capabilities, and system integration. For outpatient facilities, the ability to perform routine exams efficiently and comfortably will be most important. We also provide separate ratings for each system's ability to meet the needs of three specialized applications--breast imaging, cardiac imaging, and functional MRI.

Biomedical Technology↗
PubMed2005

The prospects for medical technology in the next decade.

Powerful forces encourage the growth of medical technology (health benefits, private equity capital, public funding, pervasive academic research, consumer demand, specialist training, reimbursement mechanisms, and industry competition). Countervailing forces that inhibit growth are the costs of the technology, difficulty in evaluating clinical and cost effectiveness, unequal patient access, and misuse, overuse, and underuse. While technology funding sources continue to expand, so do the methodologies for technology assessment. They are part of a broad movement to better manage the diffusion of medical technology. Specific proposals include more centralized planning, more discriminating federal funding, drug price controls, curtailing insurance reimbursements, more selective adoption of new technologies, and more rigorous attention to cost effectiveness. Savvy develops of and investors in new medical technology will anticipate these changes and take them into account in their planning.

Biomedical Research↗
PubMed2004

A consumer involvement model for health technology assessment in Canada.

Similar to other health policy initiatives, there is a growing movement to involve consumers in decisions affecting their treatment options. Access to treatments can be impacted by decisions made during a health technology assessment (HTA), i.e., the rigorous assessment of medical interventions such as drugs, vaccines, devices, materials, medical and surgical procedures and systems. The purpose of this paper was to empirically assess the interest and potential mechanisms for consumer involvement in HTA by identifying what health consumer organizations consider meaningful involvement, examining current practices internationally and developing a model for involvement based on identified priorities and needs. Canadian health consumer groups representing the largest disease or illness conditions reported a desire for involvement in HTA and provided feedback on mechanisms for facilitating their involvement.

Biomedical Technology↗
PubMed2005

Medical technology management: bridging the gap between theory and practice.

New medical technologies that offer to improve upon or completely replace existing ones are continuously appearing. These technologies are forcing healthcare policymakers to consistently evaluate new treatment options. However, emerging medical technology has been viewed as a significant factor in increasing the cost of healthcare. The abundance of new medical alternatives, combined with scarcity of resources, has led to priority setting, rationing, and the need for further technology management and assessment. Economic evaluation of medical technologies is a system of analysis within the framework of health technology assessment to formally compare the costs and consequences of alternative healthcare interventions. EEMT can be used by many healthcare entities, including national policymakers, manufacturers, payers and providers, as a tool to aid in resource allocation decisions. In this paper we discuss the historical evolution and potential of EEMT, the practical limitations hindering more extensive implementation of these types of studies, current efforts at improvement, and the ethical issues influencing ongoing development. The Medical Technologies Administration in Israel's Ministry of Health is given as an example of an entity that has succeeded in practically implementing EEMT to optimize healthcare resource allocation.

Biomedical Technology↗
PubMed1993

Technology evaluation in a US hospital: the role of clinical engineering.

Appropriate deployment of technological innovation contributes to improvement in the quality of healthcare delivered, containment of cost, and an increased access to the healthcare system. Hospitals have been allocating a significant portion of their resources to procuring and managing capital assets; they are continuously faced with demands for new medical equipment and are asked to manage existing inventory for which they are not well prepared. To objectively manage their investment, hospitals are developing medical technology management programmes that need pertinent information and methods for new equipment planning as well as for reduction in the ownership costs of existing equipment. Clinical engineers can identify new medical equipment, review their institution's technological position, develop equipment-selection criteria, supervise installations and monitor postprocurement performance to meet their hospital's programme's objectives. This programme, together with cost accounting analysis, will objectively guide the capital assets decisionmaking process. The result of systematic planning and execution, the programme will assure the lowest life-cycle costs at the best performance. The clinical engineer's skills and expertise are needed to facilitate the adoption of an objective methodology for implementing the programme, thus improving the match between the hospital's needs and budget projections, equipment performance and cost of ownership.

Biomedical Engineering↗