Key result
In 15 economic evaluations of TAVI, learning effects were discussed in 5 studies, incremental innovation in 7, and context-dependency in 7, indicating these challenges are rarely fully addressed.
Why the study?
Economic evaluations of medical devices face methodological challenges, and it was unknown to what extent learning effects, incremental innovation, and context dependency are addressed in TAVI evaluations.
To what extent are learning effects, incremental innovation, and context-dependency included or discussed in economic evaluations of TAVI?
Systematic Review (n=15)
To what extent are learning effects, incremental innovation, and context-dependency included or discussed in economic evaluations of TAVI?
Methodological challenges such as learning effects, incremental innovation, and context-dependency are typically only partly discussed and rarely dealt with in economic evaluations of TAVI.
TAVI economic evaluations rarely address key methodological challenges; challenges their validity for policy and extends need for improved designs.
Most collectively funded healthcare systems set limits to their benefit package. Doing so requires judgements which may involve economic evaluations. Performing such evaluations brings methodological challenges, which may be more pronounced in non-pharmaceutical interventions. For example, for medical devices, the validity of assessment results may be limited by learning effects, incremental innovation of the devices and the context-dependency of their outcomes. To review the extent to which "learning effects", "incremental innovation" (related to outcomes) and "context-dependency" are included and/or discussed in peer reviewed economic evaluations on medical devices using Transcatheter Aortic Valve Implementation (TAVI) as an example. A systematic review was performed including full economic evaluations of TAVI for operable patients with aortic stenosis identified using the Pubmed database. Study characteristics, study results and text fragments concerning the aforementioned aspects were extracted. The quality of the studies was assessed using a quality checklist (CHEC-extended). Within 207 screened records, 15 studies were identified. Two studies referred to all three aspects, four studies referred to none. "Learning effects" were discussed in five studies, one of which described a method to cope with this challenge. “Incremental innovation” was described in seven studies. Limitations in generalizability of results related to context of care provision were discussed in seven studies. The challenges related to economic evaluations of TAVI and their influence on the validity of reported results, are typically only partly discussed and rarely dealt within peer reviewed studies. It is important for better informed policy decisions that this improves.
No takes yet. Share an insight, caveat, or question.
Enzing et al. (2020) conducted a systematic review in Aortic stenosis (n=15). Transcatheter Aortic Valve Implementation (TAVI) was evaluated on Extent to which learning effects, incremental innovation, and context-dependency are included and/or discussed. In 15 economic evaluations of TAVI, learning effects were discussed in 5 studies, incremental innovation in 7, and context-dependency in 7, indicating these challenges are rarely fully addressed.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: