Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply

Abstract

Background Health technology assessments (HTAs) are an interdisciplinary method to support sustainable, evidence-based healthcare decisions. They systematically assess medical products, procedures, and technologies with respect to medical, economic, legal, social, and ethical aspects. Method This review analyzes the current use of HTAs in radiology in Germany and discusses challenges associated with HTAs. In particular, incentive structures of various players in the healthcare field involved in HTA implementation are considered for both the inpatient and outpatient sectors. Taking into account that the Joint Federal Committee (G-BA) has different authority between sectors ("ban reservation” for inpatients and “authorization right” for outpatients), we focus on the repercussions on reimbursement for new diagnosis or treatment methods by statutory health insurance companies. Results The G-BA’s authority implicitly creates a paradox in terms of incentives to implement and finance HTAs: in the outpatient sector HTAs are considered necessary to evaluate new medical services while players may not have sufficient incentive to implement and finance HTAs in the inpatient sector. Conclusion Characteristics of HTAs differ widely with respect to the items to be assessed. Therefore, an HTA for drug effectiveness is not easily transferable to radiological procedures. Within radiology, each method must be assessed individually (e. g. according to tumor stage). Despite these challenges, systematic compilation and critical assessment (regarding both cost and medical effectiveness) of available evidence should be a basic component of evidence-based radiology. As companies in healthcare fail to invest in studies that advance evidence-based radiology and considering the lack of incentive for such investments, public funding institutions need to accept the challenge to support studies that assess the benefit of radiological procedures. Key Points: Citation Format

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“…A review by Winkelmann et al . (2019) analysed the current use of HTAs in radiology in Germany and discussed challenges associated with HTA 7 . Imaging devices have a relatively short lifecycle due to constant modification and innovation making the collection of long‐term data and demonstration of incremental benefit difficult.…”

“…A review by Winkelmann et al (2019) analysed the current use of HTAs in radiology in Germany and discussed challenges associated with HTA. 7 Imaging devices have a relatively short lifecycle due to constant modification and innovation making the collection of long-term data and demonstration of incremental benefit difficult. As randomised controlled trials are not required for regulatory approval in the European Union (EU), manufacturers focus on carrying out studies that demonstrate technical advantages and features of their imaging device over existing technology, rather than focusing on its clinical utility.…”