Medical Devices at the Limits – a glimpse of the future

Medical Devices at the Limits – a glimpse of the future
Dr William Wijns
Cardiology and Diabetes at the Limits, Cape Town, Feb 2011.

An explosion in the development of medical devices has occurred over the past 2 decades with increasingly rapid cycles of evolution as technological pace has accelerated. Often the next generation of device is ready for market as the RCT’s for the previous generation are being published. This may be a limit to the development of future devices in an age of evidence based practice.

Disease substitution is also a potential problem. As one disease is resolved by devices, another may replace the original as a consequence of the device itself. An example would be coronary artery stents, which overcome stenotic lesions but cause stent thrombosis. Disease substitution leads inevitably to a need to evolve the technology (eg. drug eluting stents) thus leading to escalating cycles of cost for next generation devices and also a need for renewed RCT’s to prove the latest development. There is a limit to the costs that any health economy will bear for devices, thus it follows that there is a natural life cycle for any device in which repeated development cycles to overcome substitute diseases will eventually price it out of the market.

In essence it appears that the pace of technology change may be an increasing challenge as the speed of development outweighs the ability of RCT’s to keep pace, and the costs of technological solutions increase. In addition as the risks posed by diseases are systematically reduced through newer technologies, the cost effectiveness of any further improvements in outcomes becomes harder to establish – for instance a device which achieves 100% reduction in risk of death in a common disease will be easier for payers to justify than a next generation solution which treats a substitute disease to achieve a further smaller overall benefit.
Thus the limit to medical devices may be the speed and success of technological development itself.