The Bright Elusive Butterfly of Value in Health Technology Development; Comment on “Providing Value to New Health Technology: The Early Contribution of Entrepreneurs, Investors, and Regulatory Agencies”

Document Type : Commentary

Authors

Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

Abstract

The current system of health technology development is characterised by multiple misalignments. The “supply” side (innovation policy-makers, entrepreneurs, investors) and the “demand” side (health policy-makers, regulators, health technology assessment, purchasers) operate under different – and conflicting – logics. The system is less a “pathway” than an unstable ecosystem of multiple interacting sub-systems. “Value” means different things to each of the numerous actors involved. Supply-side dynamics are built on fictions; regulatory checks and balances are designed to assure quality, safety and efficacy, not to ensure that technologies entering the market are either desirable or cost-effective. Assessment of comparative and cost-effectiveness usually comes too late in the process to shape an innovation’s development.
 
We offer no simple solutions to these problems, but in the spirit of commencing a much-needed public debate, we suggest some tentative ways forward. First, universities and public research funders should play a more proactive role in shaping the system. Second, the role of industry in forging long-term strategic partnerships for public benefit should be acknowledged (though not uncritically). Third, models of “responsible innovation” and public input to research priority-setting should be explored. Finally, the evidence base on how best to govern inter-sectoral health research partnerships should be developed and applied.

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References

  1. Lehoux P, Miller FA, Daudelin G, Denis JL. Providing value to new health technology: the early contribution of entrepreneurs, investors, and regulatory agencies. Int J Health Policy Manag. 2017; Forthcoming. doi:10.15171/ijhpm.2017.11
  2. Lehoux P, Daudelin G, Williams-Jones B, Denis J-L, Longo C. How do business model and health technology design influence each other? Insights from a longitudinal case study of three academic spin-offs. Res Policy. 2014;43(6):1025-1038.
  3. Lehoux P, Miller F, Daudelin G, Urbach D. How venture capitalists decide which new medical technologies come to exist. Sci Public Policy. 2016;43(3):375-385.
  4. Lehoux P, Daudelin G, Hivon M, Miller FA, Denis JL. How do values shape technology design? An exploration of what makes the pursuit of health and wealth legitimate in academic spin-offs. Sociol Health Illn. 2014;36(5):738-755. doi:10.1111/1467-9566.12097
  5. Lehoux P. Why examining the desirability of health technology matters. Healthc Policy. 2008;3(3):29-39.
  6. Lehoux P. The duality of health technology in chronic illness: how designers envision our future. Chronic Illn. 2008;4(2):85-97. doi:10.1177/1742395308092475
  7. Lehoux P, Daudelin G, Demers-Payette O, Boivin A. Fostering deliberations about health innovation: what do we want to know from publics? Soc Sci Med. 2009;68(11):2002-2009. doi:10.1016/j.socscimed.2009.03.017
  8. Lehoux P, Denis JL, Rock M, Hivon M, Tailliez S. How medical specialists appraise three controversial health innovations: scientific, clinical and social arguments. Sociol Health Illn. 2010;32(1):123-139. doi:10.1111/j.1467-9566.2009.01192.x
  9. Scott WR. Institutions and Organizations: Ideas, Interests, and Identities. Sage Publications; 2013.
  10. Chesbrough H, Rosenbloom RS. The role of the business model in capturing value from innovation: evidence from Xerox Corporation's technology spin‐off companies. Industrial and Corporate Change. 2002;11(3):529-555.
  11. Leonardi PM, Barley SR. What’s under construction here? Social action, materiality, and power in constructivist studies of technology and organizing. Acad Manag Ann. 2010;4(1):1-51.
  12. Brown N. Hope against hype-accountability in biopasts, presents and futures. Science & Technology Studies. 2003;28(2):3-21.
  13. Markiewicz K, van Til JA, MJ IJ. Medical devices early assessment methods: systematic literature review. Int J Technol Assess Health Care. 2014;30(2):137-146. doi:10.1017/s0266462314000026
  14. HM Treasury Department of Culture MaS. Next Generation Mobile Technologies: A 5G Strategy for the UK. London: Stationery Office; 2017. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/597421/07.03.17_5G_strategy_-_for_publication.pdf.  Accessed March 8, 2017.
  15. Greenhalgh T, Swinglehurst D, Stones R. Rethinking ‘resistance’ to big IT: A sociological study of why and when healthcare staff do not use nationally mandated information and communication technologies. Health Services and Delivery Research. 2014;39(2):1-86. doi:10.3310/hsdr02390
  16. Grunwald A. Responsible innovation: bringing together technology assessment, applied ethics, and STS research. Enterprise and Work Innovation Studies. 2011;31:10-19.
  17. Von Schomberg R. A vision of responsible research and innovation. In: Owen R, Heintz M, Bessant J, eds. Responsible innovation: Managing the responsible emergence of science and innovation in society. West Sussex, UK: John Wiley; 2013:51-74.
  18. Owen R, Macnaghten P, Stilgoe J. Responsible research and innovation: From science in society to science for society, with society. Sci Public Policy. 2012;39(6):751-760.
  19. Stilgoe J, Owen R, Macnaghten P. Developing a framework for responsible innovation. ResPolicy. 2013;42(9):1568-1580.
  20. UK Department of Health (NHS Improvement and Efficiency Directorate). Innovation, Health and Wealth: Accelerating adoption and diffusion in the NHS. London: Department of Health; 2011. http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_134597.pdf.  Accessed February 18, 2017.
  21. Smith J. Technological innovation in health care: Report of the Standing Commission on Health. Ottawa: Government of Canada; 2013. http://www.parl.gc.ca/HousePublications/Publication.aspx?Language=e&Mode=1&Parl=41&Ses=1&DocId=6221741.  Accessed February 17, 2017.
  22. Garber S, Gates S, Keeler EB, et al. Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value.  Santa Monica, CA: RAND Corporation; 2014. http://www.rand.org/pubs/research_reports/RR308.html. Accessed February 17, 2017.
  23. Bienkowska-Gibbs T, Exley J, Saunders CL, et al. Evaluating the Role and Contribution of Innovation to Health and Wealth in the UK: A Review of Innovation, Health and Wealth: Phase 1 Final Report. Rand Health Quarterly. 2016;6(1).
  24. Naylor D, Fraser N, Girard F, Jenkins T, Mintz J, Power C. Unleashing innovation: Excellent healthcare for Canada. Report of the Advisory Panel on Healthcare Innovation. Ottawa: Health Canada; 2015. http://www.healthycanadians.gc.ca/publications/health-system-systeme-sante/report-healthcare-innovation-rapport-soins/alt/report-healthcare-innovation-rapport-soins-eng.pdf.  Accessed February 26, 2017.
  25. Walshe K, McKee M, McCarthy M, et al. Health systems and policy research in Europe: Horizon 2020. Lancet. 2013;382(9893):668. doi:10.1016/S0140-6736(12)62195-3
  26. Edgerton D. Time for evidence based research policy. British Medical Journal Publishing Group; 2016.
  27. Emanuel EJ. The future of biomedical research. JAMA. 2013;309(15):1589-1590.
  28. Walshe K, McKee M, Groenewegen P, et al. Reshaping the agenda of the European Commission for the health systems and policy research in Europe within Horizon 2020. Epidemiology, Biostatistics and Public Health. 2013;10(2).
  29. Greenhalgh T, Russell J. Why do evaluations of ehealth programs fail? an alternative set of guiding principles. PLoS Med. 2010;7(11):e1000360. doi:10.1371/journal.pmed.1000360
  30. Lowe C. Telehealth Soapbox: Time to bid farewell to the Whole Systems Demonstrator? Telehealth & Telecare Aware. PublishedJuly 22, 2013. Accessed March 12, 2017. http://telecareaware.com/telehealth-soapbox-time-to-bid-farewell-to-the-wsd/. 
  31. Petit-Zeman S, Firkins L, Scadding JW. The James Lind Alliance: tackling research mismatches. Lancet. 2010;376(9742):667-669. doi:10.1016/S0140-6736(10)60712-X
  32. Deane KH, Flaherty H, Daley DJ, et al. Priority setting partnership to identify the top 10 research priorities for the management of Parkinson's disease. BMJ Open. 2014;4(12):e006434. doi:10.1136/bmjopen-2014-006434
  33. Chalmers I, Bracken MB, Djulbegovic B, et al. How to increase value and reduce waste when research priorities are set. Lancet. 2014;383(9912):156-165. doi:10.1016/S0140-6736(13)62229-1
  34. Greenhalgh T, Wherton J, Sugarhood P, Hinder S, Procter R, Stones R. What matters to older people with assisted living needs? A phenomenological analysis of the use and non-use of telehealth and telecare. Soc Sci Med. 2013;93:86-94. doi:10.1016/j.socscimed.2013.05.036
  35. Greenhalgh T, Stramer K, Bratan T, et al. The Devil's in the Detail: Final report of the independent evaluation of the Summary Care Record and HealthSpace programmes. London: University College London; 2010.
  36. Villa S, Compagni A, Reich MR. Orphan drug legislation: lessons for neglected tropical diseases. Int J Health Plann Manage. 2009;24(1):27-42. doi:10.1002/hpm.930
  37. Hanney S, Kuruvilla S, Soper B, Mays N. Who needs what from a national health research system: lessons from reforms to the English Department of Health's R&D system. Health Res Policy Syst. 2010;8:11. doi:10.1186/1478-4505-8-11
  38. Ferlie E, Fitzgerald L, McGivern G, Dopson S, Bennett C. Making Wicked Problems Governable? The Case of Managed Networks in Health Care. Oxford: OUP; 2013.
  39. Ramaswamy V, Ozcan K. The Co-creation Paradigm. Stanford University Press; 2014. 

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History

  • Receive Date: 26 March 2017
  • Revise Date: 20 May 2017
  • Accept Date: 20 May 2017
  • First Publish Date: 01 January 2018

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