European Heart Journal Advance Access originally published online on February 13, 2006
European Heart Journal 2006 27(7):882-885; doi:10.1093/eurheartj/ehi794
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Improving patient access to novel medical technologies in Europe
1Department of Cardiology, Cork University Hospital Wilton, Cork, Ireland
2Guidant Europe, Park Lane, Culliganlaan 2B, Diegem, Belgium
3Universitätssklinikum Münster, Albert-Schweitzer Strasse 33, Münster, Germany
4National Institute for Health and Clinical Excellence, MidCity Place, London, UK
5Clinique Pasteur, Unité de Cardiologie Interventionnelle, Toulouse Cedex 3, France
6Wessex Cardiac Centre, Southampton University Hospital, Southampton, UK
7IRCCS Fondazione Salvatore Maugeri, Department of Molecular Cardiology, Pavia, Italy
8DIMDI–German Institute of Medical Documentation and Information, Waisenhausgasse, Köln, Germany
9Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham, UK
10European Society of Cardiology (ESC), 2035, Route des Colles, BP 179, F-06903, Sophia Antipolis, France
Received 19 January 2006; accepted 26 January 2006; online publish-ahead-of-print 13 February 2006.
* Corresponding author. Tel: +353 21 494 1349; fax: +353 21 494 1354. E-mail address: peterkearney{at}eircom.net
Abstract
The European Society of Cardiology (ESC) organized a one-day workshop with clinicians, health economic experts, and health technology appraisal experts to discuss the equity of patient access to novel medical technologies in Europe. Two index technologies were considered: implantable cardioverter defibrillators (ICDs) and drug-eluting stents (DES). The use of ICDs range from 35 implants/million population in Portugal to 166 implants/million population in Germany, whereas for implants of DES (as percentage of total stents) it is lowest in Germany at 14% and high in Portugal at 65%. These differences can in part be explained by a lack of structured implementation of guidelines, the direct cost in relation to the overall healthcare budget, and to differences in procedures and models applied by Health Technology Assessment (HTA) agencies in Europe. The workshop participants concluded that physicians need to be involved in a more structured way in HTA and need to become better acquainted with its methods and terminology. Clinical guidelines should be systematically translated, explained, disseminated, updated, and adopted by cardiologists in Europe. Clinically appropriate, consistent and transparent health economic models need to be developed and high-quality international outcome and cost data should be used. A process for funding of a technology should be developed after a positive recommendation from HTA agencies. Both the ESC and the national cardiac societies should build-up health economic expertise and engage more actively in discussions with stakeholders involved in the provision of healthcare.
Key Words: Health technology assessment • DES • Drug eluting stents • ICD • Implantable cardioverter defibrillators • Health economics • ESC guidelines • Funding