Impact of Health Technology Assessment on Innovation Diffusion: the case of techniques in Interventional Radiology

Objectives: Interventional Radiology (IR) is a medical specialty consisting of minimally invasive image-guided techniques. It is one of many leading medical innovations with a great potential in cancer treatment, especially. Benefits reside in lower cost, shorter hospital stay and less side effects; it can be sometimes the only available therapy. Yet the diffusion of this innovation is substantially slow considering its age. Health Technology Assessment (HTA), by evaluating health technologies, contributes to the social construction of the value of medical innovation thus leading to its diffusion. Our purpose is to evaluate to which extent and speed has IR been the subject of HTA. Bibliometrics would give us an idea on the diffusion and rate of adoption of IR techniques. Methods: We focus on 7 IR techniques in oncology: chemo- or uterine fibroid embolization, cryo- or microwave or radiofrequency ablation (RFA), high-intensity focused ultrasound and laser ablation. First, we identified the different techniques terminology and ran complex keywords queries (n=21) in combination with the topics cancer, organs, imagery techniques and HTA. 3 databases were used (PubMed, Scopus & Cochrane Library). Data was also collected from Factiva® to identify any socio-economic echo of media interest. The data gathered concerned publication date, volume, affiliation, country, and author. For each technique, we looked at the oldest most accurate publication marking the birth of a technique, organs or medical imaging specificities and the HTA publications. Analysis was realized using Intellixir statistical content and text mining software. Results: Most of the IR techniques appeared in the ‘80s & ‘90s. Since, the trends of IR, and HTA related, publications were relatively slow. The majority of IR techniques has a significant interest in hepatic oncology. The RFA has known great interest by both authors and the public accompanied by an explosion of its use. The leading publishing countries were the US and UK. Few HTA publications concerning IR techniques in oncology have been published. But there is a great correlation between the papers' number on a technique and HTA related papers' number for this technique. The delay between the dates of the first technique related publication and its relevant HTA related publication varies widely. Discussion: The diffusion of an innovative IR technique is correlated with the economic evaluation of the technique and the comparison to other competing therapies such as surgery and pharmacotherapy. Both, the innovation and its evaluation are influenced by the interest of the public in it. This confirms Rogers diffusion of innovation theory concerning the 2 of the 5 features for the diffusion of an innovation: triability and observability.