Utilization of innovative medical technologies in German inpatient care: does evidence matter?

Health Research Policy and Systems

Research

Hanna Ermann¹  Tanja Rombey¹  Helene Eckhardt¹  Dimitra Panteli¹  Sabine Fuchs¹  Hendrikje Rödiger¹  Susanne Felgner²  Reinhard Busse²  Marie Dreger²  Cornelia Henschke² 

[1] Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany;Department of Health Care Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany;Berlin Centre for Health Economics Research (BerlinHECOR), Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany;

关键词: Medical devices;    Evidence-based medicine;    Value based health care;    Evidence gaps;    Implementation science;    Diffusion of innovation;    Health technology assessment;    Financial incentives;    Disinvestment;    Hospital;    Germany;   

DOI  :  10.1186/s12961-023-01047-w

 received in 2021-11-15, accepted in 2023-08-26,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe reimbursement of new technologies in inpatient care is not always linked to a requirement for evidence-based evaluation of patient benefit. In Germany, every new technology approved for market was until recently eligible for reimbursement in inpatient care unless explicitly excluded. The aim of this work was (1) to investigate the type of evidence that was available at the time of introduction of 25 innovative technologies and how this evidence evolved over time, and (2) to explore the relationship between clinical evidence and utilization for these technologies in German inpatient care.MethodsThis study combined different methods. A systematic search for evidence published between 2003 and 2017 was conducted in four bibliographic databases, clinical trial registries, resources for clinical guidelines, and health technology assessment—databases. Information was also collected on funding mechanisms and safety notices. Utilization was measured by hospital procedures captured in claims data. The body of evidence, funding and safety notices per technology were analyzed descriptively. The relationship between utilization and evidence was explored empirically using a multilevel regression analysis.ResultsThe number of included publications per technology ranges from two to 498. For all technologies, non-comparative studies form the bulk of the evidence. The number of randomized controlled clinical trials per technology ranges from zero to 19. Some technologies were utilized for several years without an adequate evidence base. A relationship between evidence and utilization could be shown for several but not all technologies.ConclusionsThis study reveals a mixed picture regarding the evidence available for new technologies, and the relationship between the development of evidence and the use of technologies over time. Although the influence of funding and safety notices requires further investigation, these results re-emphasize the need for strengthening market approval standards and HTA pathways as well as approaches such as coverage with evidence development.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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