Selection and Prioritization of Medical Devices for HTA Evaluation: A Systematic Review of Existing Approaches.

Abstract

Background: Efficient resource allocation in the health technology assessment process of medical devices requires a robust selection and prioritization of medical devices for evaluation. Despite its importance, there is currently no generally accepted approach for such a prioritization task, and a comprehensive review of adaptable approaches is needed.

Objective: Our study aimed to provide a comprehensive review of existing approaches that could be used or adapted to select and prioritize medical devices for health technology assessment (HTA) evaluation.

Methods: Searches were conducted in PubMed, Web of Science, Scopus, and the databases of the International Network of Agencies for Health Technology Assessment and the Centre for Reviews and Dissemination. Following the screening, analyses and comparisons were based on data such as publication year, target jurisdiction, decision context, health technology focus, methods used for value assessment and included attributes, and the social methods used for stakeholder engagement.

Results: From 1055 identified records, 51 studies were eligible for review. Only 31 records mentioned the value assessment method used and, although there was a wide variety of techniques found in this sample, the majority of them (77%) applied multicriteria decision analysis. A total of 22 studies were specifically focused on HTA prioritization and, within this set, the most frequently used value attributes were Clinical efficacy and/or effectiveness (n = 21, 95%), Impact of the disease (n = 13, 59%), and Ethical, social and legal aspects (n = 11, 50%). Social methods commonly implemented were questionnaires/surveys and the Delphi technique, with 15 and 7 reported applications, respectively.

Conclusions: A wide variety of methods have been reported to assess value in HTA contexts, and our premise that a generally accepted approach for prioritizing medical devices for HTA is still lacking was confirmed. Despite such heterogeneity, it was noticed that a multicriteria decision analysis is predominantly applied, with both intervention- and disease-related attributes being considered. Underreporting of the approaches used was recurrent, which should be avoided in the future to ensure their transparency and replicability.