Assessing Medical Technologies (1985) / Chapter Skim
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6. Medical Technology Assessment in Developed Countries: Trends and Opportunities for Collaboration
6. Medical Technology Assessment in Developed Countries: Trends and Opportunities for Collaboration
Pages 228-243
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From page 228... ...
Developing countries try to emphasize simple and effective technologies that the countries can afford, but industrialized countries ask whether the rapid development of highly sophisticated technology overshoots the target, serves the medical professions more than the patients, and drives health care costs too high. This latter concern, the interest of industrialized countries in technology assessment and how better to foster international collaboration, is the subject of this chapter.
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8.6 5.6 9 5b 10.0 (1982-1983) Belgium Denmark Greece West Germany France Ireland Italy Luxembourg The Netherlands United Kingdom United Statesa Sweden a U.s.
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S dollars Country BMRD Funding 5,256 1,523 1,271 712 495 299 257 251 229 176 122 94 69 52 41 32 Percentage of Total BMRD in all Countries 4g.18 13.96 11.65 6.53 4.54 2.74 2.37 2.30 2.10 1.62 1.13 0.86 0.63 0.48 0.37 0.29 14 0.13 10 0.09 6 0.05 United States Japan West Germany France United Kingdom Italy The Netherlands Sweden Switzerland Canada Belgium Denmark Australia Spain Norway Finland New Zealand Portugal Ireland a Includes public and private funds.
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Britain invests more per capita than any other country in clinical trials because the total costs of patient care already are borne by the National Health Service (OTA, 1980~. The apparent costs are low in comparison with the cost of trials in the United States, where some patient care costs must come from research funding.
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The addition of economic and social considerations on the Swedish consensus exercise provides an interesting model for other countries. More recently, Britain sponsored a consensus development conference on its coroASSESSING MEDICAL TECHNOLOGY nary artery bypass surgery (Coronary Artery Bypass Surgery: A Consensus, 1984; Stocking and Jennett, 1984~.
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scanners, kidney transplants, and radiation units (Table 6-4~. There appear to be substantial differences from country to country in both the numbers of operations and the numbers of 233 TABLE 6-3 Use of Pacemakers in Selected Countries in 1978 Country United States Canada Australia United Kingdom SOURCE: Seizer (1983)
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For example, despite the desire in the United States for an improved pertussis vaccine such as the one made and accepted for use in Japan, the vaccine must undergo clinical trials with a possible delay of 4 years before licensure in the United States. Nevertheless, efforts are under way by the European Free Trade Association, the European Economic Community, and the World Health Organization (WHO)
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A closer look at some aspects of drug approval in France and in West Germany reveals some problems faced in information exchange. However, it also is apparent that similar information is required in both countries for determining safety and efficacy and that great benefits would occur from efforts to systematize collection and exchange of such data.
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From page 236... ...
However, language differences and differences in attitudes about aspects of the methodology or ethics of clinical trials may raise barriers to the conduct of trials in West Germany under protocols acceptable to France or other countries. Despite efforts for harmonization, drug regulation in Europe is still far from being coordinated, and the auspices for mutual agreement regarding the acceptance of new drugs or the acknowledgment of data are still rather poor (Gross, 1980~.
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Criteria used for evaluation were deemed too narrow and too inattentive to patient reactions or to the social and psychological consequences of innovation. The report favored establishment of a national institute of health services research to coordinate and commission research on important technologies including clinical trials; the analysis of costs; and epidemiological, psychosocial, and policy studies.
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Fees for each service are negotiated on an annual basis within the Central Social Insurance Medical Council, an advisory body to the Ministry of Health and Welfare made up of representatives from medicine, dentistry, insurance plans, and other relevant groups. Because of the rapid development and dissemination of new medical technology in Japan, evaluation has been ignored in ASSESSING MEDICAL TECHNOLOGY many instances or set aside for future action.
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TABLE 6-5 MEDLARS Foreign Centers' Access to Tapes Tapes/Software On-Line NEM West Germany Japan Sweden United Kingdom Australia France South Africa Canada Pan American Health Mexico Organization Colombia Kuwait Italy Switzerland SOURCE: OTA, 1982a.
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Future programs will be held on economic incentives for the appropriate and rational use of medical technologies in different member states; coordinaASSESSING MEDICAL TECHNOLOGY tion of national standards for health care facilities, equipment and procedures; technology at the primary health care level; and geographic variation in use of health services. The establishment in 1984 of a new journal, The International journal of Technology Assessment in Health Care (Reiser, 1983)
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Therefore, it is not surprising that more progress appears to have been made toward international collaboration in the assessment of drugs than in the assessment of devices or medical practices. The presence of national organizations charged with drug evaluation provides a focus for these activities and facilitates international collaboration.
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Office for Medical Applications of Research responsible for the consensus conferences is currently funding research both to formalize and improve the consensus process and to find out how to enhance their impacts. · Industrialized nations with competence in medical technology assessment should work with less-developed countries to help them fill their special needs for information.
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From page 243... ...
1984. Consensus development conference: Coronary artery bypass surgery in Britain.
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