Comments

Health Affairs encourages readers to engage in discussion via comments on our Web site.

• To RESPOND to a particular article: Click on the link "Submit a response to this article" in the box at the top right-hand corner of the article.
• To READ responses to a particular article: Click on the link "View responses" in the box at the top right-hand corner of the article.

Comments to:

James C. Robinson Value-Based Purchasing For Medical Devices Health Affairs, November/December 2008; 27(6): 1523-1531. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

Comments:Submit a response to this article

Comments published:

Value-Based Purchasing Does Not Work For Drugs

Alain Braillon, M.D.   ( 3 December 2008 )

Relationship Between Surgeon-Inventors And Device Companies

Greg Garden   ( 30 March 2009 )

Value-Based Purchasing Does Not Work For Drugs 3 December 2008
Alain Braillon, M.D., Public Health Centre Hospitalier Universitaire d' Amiens (France) Send comment to journal: Re: Value-Based Purchasing Does Not Work For Drugs braillon.alain{at}chu-amiens.fr Alain Braillon, M.D.	James Robinson wants to apply the cost-effectiveness analysis in purchase decisions for medical devices. Indeed, the price paid must relate to the social value of the product. There is extensive experience of this principle for drugs. Here is a French example of what is happening all over the world. For hypertension, the French health care watchdog recently recommended the prescription of the lowest price ACE inhibitor and the use of ARBs (which have a mean higher price) in case of cough (an adverse effect less frequent with ARBs than ACE inhibitors).[1] Indeed, both classes give the same benefits in outcome for mortality and morbidity. A lot of money can be saved: treatment with Captopril and its generics costs 0.33 euro a day, while for Valsartan (the most costly ARB) it costs 0.74 euro a day. Surprisingly, the highest cost is for an ACE inhibitor (Perindopril, from the French company Servier): 0.82 euro a day. Why are there such discrepancies? The national pricing committee decides prices on the basis of evidence: the effectiveness and an epidemiological analysis performed by the health care watchdog. Obviously, pricing and cost-effectiveness analysis are beyond the capabilities of national agencies and committees. To believe that the challenge for medical devices is only an organizational fragmentation between hospitals and surgeons is shortsighted. NOTE 1. Haute Autorité de Santé, Les inhibiteurs du système rénine-angiotensine dans l’HTA essentielle non compliquée: Comment choisir entre IEC et sartans? http://www.has-sante.fr/portail/upload/docs/application/pdf/2008-10/fiche_iec_sartans_011008.pdf
Relationship Between Surgeon-Inventors And Device Companies 30 March 2009
Greg Garden, CEO Medical Device Launchpad Send comment to journal: Re: Relationship Between Surgeon-Inventors And Device Companies contact{at}medicaldevicelaunchpad.com Greg Garden	The issues raised in the article and the conclusions reached are very accurate. The current administration is having a lot of discussion around the issue; however, not talking about the relationships between inventors and device companies with respect to reining in the cost of health care is like not talking about the pink elephant in the room. For quite some time our firm and many others have spent countless hours and resources reaching out to legislators, device companies, and inventors -- all of whom insist that they support the "self-regulated" Advamed guidelines, requesting their participation in a free-market system for introducing new IP to market, yet the idea seems to capture no traction. It is our belief that if the surgeon and invention are blind to companies at the time of negotiating the purchase of IP, there are a number of positive monetary effects that ultimately minimize the cost of the product being produced. Overvaluation of IP is minimized, and companies are less likely to purchase IP that has no significant advancement to clinical outcomes under the guise of filling product pipelines, when in fact it is just an indirect payment to a surgeon for their business. There are a number of potentially positive outcomes associated with surgeon-inventors' names remaining blind until the negotiations are finalized, allowing companies to only view the clinical peer-reviewed articles, valuation, and other data necessary for appropriate due diligence, not the name of the surgeon, hospital, or other affiliation. This is such a simple thing to do, and yet one has to wonder why none of the "self-regulated" parties involved are jumping on board with this concept.