Health technology assessment (HTA) in medical device procurement has been instrumental in determining the value of medical devices. However, the unique characteristics of these devices, including frequent iterations and user learning curves, make generalising outcomes challenging. Furthermore, the diverse needs of stakeholders often result in varying views on a technology’s value. Despite the wealth of information available on HTA, a knowledge gap exists regarding its use by non-payer, non-HTA stakeholders in their assessment of medical devices.
In an attempt to bridge this gap, the ISPOR Medical Devices and Diagnostics Special Interest Group conducted a systematic literature review. These studies were geographically diverse, originating from various locations globally. Two studies each were conducted in the United States, the United Kingdom, and Canada. Other studies were based in Italy, Australia, and South Africa. This review aimed to summarise the current evidence base for the criteria used in medical device procurement.A key finding across all studies was the utilisation of decision-making criteria that are generally considered standard elements of HTA. The most common criteria included cost (reported in 100% of the studies), safety (91%), efficacy (82%), cost-effectiveness (64%), and budget impact (36%). The results, however, showed sparse evidence regarding HTA’s use in device purchasing, making it difficult to draw firm conclusions about HTA’s impact on procurement.
The use and impact of HTA on treatment decisions vary widely across different geographies, further complicating the process. However, a growing trend towards “mini” or hospital-level HTA, which directly informs procurement decisions, has been observed. Most hospital-level HTA studies reviewed continue to depend on national-level HTA. They also use published systematic reviews to shape their conclusions.
The ISPOR Special Interest Group anticipates that HTA has more impact than their findings suggest, possibly due to a lack of publication incentive among procurement bodies. We need to deepen our research to comprehend the relationship between HTA and procurement better. Encouraging broader, more systemic evidence-based decision making also requires our attention.
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