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The impact of HTA and procurement practices on the selection and prices of medical devices

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  • Callea, Giuditta
  • Armeni, Patrizio
  • Marsilio, Marta
  • Jommi, Claudio
  • Tarricone, Rosanna

Abstract

Technological innovation in healthcare yields better health outcomes but also drives healthcare expenditure, and governments are struggling to maintain an appropriate balance between patient access to modern care and the economic sustainability of healthcare systems. Health Technology Assessment (HTA) and centralized procurement are increasingly used to govern the introduction and diffusion of new technologies in an effort to make access to innovation financially sustainable. However, little empirical evidence is available to determine how they affect the selection of new technologies and unit prices. This paper focuses on medical devices (MDs) and investigates the combined effect of various HTA governance models and procurement practices on the two steps of the MD purchasing process (i.e., selecting the product and setting the unit price). Our analyses are based on primary data collected through a national survey of Italian public hospitals. The Italian National Health Service is an ideal case study because it is highly decentralized and because regions have adopted different HTA governance models (i.e., regional, hospital-based, double-level or no HTA), often in combination with centralized regional procurement programs. Hence, the Italian case allows us to test the impact of different combinations of HTA models and procurement programs in the various regions. The results show that regional HTA increases the probability of purchasing the costliest devices, whereas hospital-based HTA functions more like a cost-containment unit. Centralized regional procurement does not significantly affect MD selection and is associated with a reduction in the MD unit price: on average, hospitals located in regions with centralized procurement pay 10.1% less for the same product. Hospitals located in regions with active regional HTA programs pay higher prices for the same device (+23.2% for inexpensive products), whereas hospitals that have developed internal HTA programs pay 8.3% on average more for the same product.

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  • Callea, Giuditta & Armeni, Patrizio & Marsilio, Marta & Jommi, Claudio & Tarricone, Rosanna, 2017. "The impact of HTA and procurement practices on the selection and prices of medical devices," Social Science & Medicine, Elsevier, vol. 174(C), pages 89-95.
    • Handle: RePEc:eee:socmed:v:174:y:2017:i:c:p:89-95
    DOI: 10.1016/j.socscimed.2016.11.038
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    Cited by:

    1. Mehmet Akif Demircioglu & Roberto Vivona, 2021. "Positioning public procurement as a procedural tool for innovation: an empirical study [Creating the Conditions for Radical Public Service Innovation]," Policy and Society, Darryl S. Jarvis and M. Ramesh, vol. 40(3), pages 379-396.
    2. Tarricone, Rosanna & Amatucci, Fabio & Armeni, Patrizio & Banks, Helen & Borsoi, Ludovica & Callea, Giuditta & Ciani, Oriana & Costa, Francesco & Federici, Carlo & Torbica, Aleksandra & Marletta, Marc, 2021. "Establishing a national HTA program for medical devices in Italy: Overhauling a fragmented system to ensure value and equal access to new medical technologies," Health Policy, Elsevier, vol. 125(5), pages 602-608.
    3. Eremina, Anastasia & Zoroastrova, Irina & Maksimov, Andrey, 2018. "Empirical analysis of municipal peculiarities influence on price outcomes of public purchases," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 51, pages 84-101.
    4. Patrizio Armeni & Michela Meregaglia & Ludovica Borsoi & Giuditta Callea & Aleksandra Torbica & Francesco Benazzo & Rosanna Tarricone, 2023. "Collecting Physicians’ Preferences on Medical Devices: Are We Doing It Right? Evidence from Italian Orthopedists Using 2 Different Stated Preference Methods," Medical Decision Making, , vol. 43(7-8), pages 886-900, October.
    5. Dubas-Jakóbczyk, K. & Albreht, T. & Behmane, D. & Bryndova, L. & Dimova, A. & Džakula, A. & Habicht, T. & Murauskiene, L. & Scîntee, S.G. & Smatana, M. & Velkey, Z. & Quentin, W., 2020. "Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019: a comparative analysis," Health Policy, Elsevier, vol. 124(4), pages 368-379.
    6. Andrea Riganti, 2021. "Containing costs in the Italian local healthcare market," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 1001-1014, May.
    7. Blankart, Carl Rudolf & Dams, Florian & Penton, Hannah & Kaló, Zoltán & Zemplényi, Antal & Shatrov, Kosta & Iskandar, Rowan & Federici, Carlo, 2021. "Regulatory and HTA early dialogues in medical devices," Health Policy, Elsevier, vol. 125(10), pages 1322-1329.

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