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Affordable medical technologies: bringing Value-Based Design into global health
  1. J W DePasse1,
  2. A Caldwell2,3,
  3. D Santorino4,
  4. E Bailey2,3,
  5. S Gudapakkam2,3,
  6. D Bangsberg2,3,5,
  7. K R Olson2,5
  1. 1Department of Internal Medicine, Brown University, Providence, Rhode Island, USA
  2. 2Consortium for Affordable Medical Technology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Mass General Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4Consortium for Affordable Medical Technology, Mbarara University of Science & Technology, Mbarara, Uganda
  5. 5Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr J W DePasse, Department of Internal Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, USA; jacquelinedepasse{at}gmail.com

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Background

The implementation of the Affordable Care Act (ACA) has spurred a renewed focus on the concept of value, or health outcome per cost expended.1 Though interventions have generally centred around insurance reform and healthcare delivery, medical technology comprises a significant component of US healthcare costs and is an underemphasised sector in the push for reform. The drivers of medical technology costs, accounting for as much as 65% of the increase in overall healthcare spending, include developing new or improved medical procedures, pharmaceutical products and devices or diagnostics.2

Currently, medical technology development and sales are concentrated in high income countries (HICs). In 2009, approximately 75% of the sales of medical devices were in the USA, Japan and Europe.3 Currently, only 13% of manufacturers are located in low and middle income countries (LMICs). Despite this asymmetric market, there is both growing interest and market potential in investing in health technologies in LMICs, as evidenced by a recent WHO report analysing medical devices in LMICs.4 Nine of the top 10 medical device companies state in their annual report that they hope to expand their activities in emerging markets.5 In Africa alone, there has been a 7.5% annual increase in the importation of medical devices.6

With a new emphasis on value in the US healthcare sector, and an increased interest globally in the development of medical technologies, investing in low cost health technologies could be of mutual benefit to both high and low income countries.4 In addition to filling a great need in LMICs, ideas can flow from LMICs to more developed countries in a process called Reverse Innovation.7

Traditional medical technology innovation arises in academic medical centres, pharmaceutical companies or biotechnology companies in HICs. In the traditional model, products were stripped down or donated …

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