HTAi15 IRG Advanced Searching Workshop: Medical Devices

6fc2d5ec66494f79a6697a2c123adc2aIt has been little over a month since the HTAi2015 Annual Meeting in Oslo. I had better start writing about it! I only attended the HTAi Information Resources Group (IRG) pre-conference workshop this time as the conference content wasn’t very relevant to the job I have now. The day after EAHIL, I flew to Oslo and arrived fairly late. The workshop was the next day so I went straight to bed. I was looking forward to this workshop as there were some great presenters lined up and some interesting sessions planned. The workshop was divided into three sessions with mini sessions in the last session. It was a very full-on day but very worthwhile. The first session focused on medical devices, a topic I am not familiar with but needing to know more of. What are medical devices? Well first off, they are not drugs and do not work in a immunologic, pharmacologic, or metabolic action on or in the body, but may be assisted by these. Devices can be machines, software, reagent, instrument, implant, appliance, or apparatus. The market for devices in the UK is 11bn pa, just 2bn under the pharma market, so it is big business. Devices are tightly regulated in that they must work as described by the manufacturer and are safe, so there is a fair amount of information available about these aspects. But what about other sorts of information needed for decision-making? Information about devices is muddied by lots of issues like multiple manufacturers, limited and slow development (long follow-up), difficulties with adverse effects reporting and difficulties with effectiveness trials (RCTs not considered the best study design / small sample sizes). There are also other problems such as multiple device names, limited subject headings available (eg Adverse Events subheading in Medline refers to drugs only) and the fact that a lot of information and evidence about devices is grey literature (and could be further muddied by devices being used for purposes other than the intended one). There are some moves to improve information. One is the AdvanceHTA project which has created a taxonomy for devices. After testing on completed HTAs, it seems to be working. The other is the IDEAL Framework which aims to describe each stage of evaluation and the study designs and reporting frameworks that best suit each stage. There is a series about this in the BMJ. However, the main thrust of this session was how the Scottish Health Technologies Group (SHTG) disseminate information about devices. SHTG have a number of evidence products they produce (freely available but Scotland NHS context) and these are based on questions they receive from topic requests. The resources used to produce thesr reports are local information first, then Cochrane, ECRI, EUNetHTA POP, then primary studies and trials registries.Horizon scanning resources (such as Euroscan) are used for some reports. SHTG is currently evaluating their new Innovative Medical Technology Overview (IMTO) information product. Device manufacturers submit evidence about their products that they want adopted by NHSScotland to the SHTG which then evaluate it. The final product includes economic, device performance, and patient, organisational and safety considerations. These reports are sent directly to managers and procurement departments. Other evidence reports are disseminated to decision and policy makers, and clinicians via a variety of means.

Take home message: as Australian and UK health services are similar, it is worthwhile checking out SHTG reports and including them in your evidence reviews. Also, keep in mind that the evidence base around devices is of lower quality than pharmaceuticals. However, if clinicians at your workplace are conducting trials of surgical interventions, consider alerting them to the IDEAL Framework. I will be notifying the New Technologies committee about this.

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