Incorporating patient-preference evidence into regulatory decision making

Martin P Ho; Juan Marcos Gonzalez; Herbert P Lerner; Carolyn Y Neuland; Joyce M Whang; Michelle McMurry-Heath; A Brett Hauber; Telba Irony

doi:10.1007/s00464-014-4044-2

Incorporating patient-preference evidence into regulatory decision making

Surg Endosc. 2015 Oct;29(10):2984-93. doi: 10.1007/s00464-014-4044-2. Epub 2015 Jan 1.

Authors

Martin P Ho¹, Juan Marcos Gonzalez², Herbert P Lerner³, Carolyn Y Neuland⁴, Joyce M Whang⁵, Michelle McMurry-Heath^{6

7}, A Brett Hauber⁸, Telba Irony⁹

Affiliations

¹ Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Building 66, Room 2232, Silver Spring, MD, 20993-0002, USA. martin.ho@fda.hhs.gov.
² RTI Health Solutions, Durham, USA. jgonzalez@rti.org.
³ Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Building 66, Room 2232, Silver Spring, MD, 20993-0002, USA. herbert.lerner@fda.hhs.gov.
⁴ Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Building 66, Room 2232, Silver Spring, MD, 20993-0002, USA. carolyn.neuland@fda.hhs.gov.
⁵ Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Building 66, Room 2232, Silver Spring, MD, 20993-0002, USA. joyce.whang@fda.hhs.gov.
⁶ Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Building 66, Room 2232, Silver Spring, MD, 20993-0002, USA. michelle.mcmurry-heath@fda.hhs.gov.
⁷ FaegreBD Consulting, Washington, USA. michelle.mcmurry-heath@fda.hhs.gov.
⁸ RTI Health Solutions, Durham, USA. abhauber@rti.org.
⁹ Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Building 66, Room 2232, Silver Spring, MD, 20993-0002, USA. telba.irony@fda.hhs.gov.

PMID: 25552232
DOI: 10.1007/s00464-014-4044-2

Abstract

Background: Patients have a unique role in deciding what treatments should be available for them and regulatory agencies should take their preferences into account when making treatment approval decisions. This is the first study designed to obtain quantitative patient-preference evidence to inform regulatory approval decisions by the Food and Drug Administration Center for Devices and Radiological Health.

Methods: Five-hundred and forty United States adults with body mass index (BMI) ≥ 30 kg/m(2) evaluated tradeoffs among effectiveness, safety, and other attributes of weight-loss devices in a scientific survey. Discrete-choice experiments were used to quantify the importance of safety, effectiveness, and other attributes of weight-loss devices to obese respondents. A tool based on these measures is being used to inform benefit-risk assessments for premarket approval of medical devices.

Results: Respondent choices yielded preference scores indicating their relative value for attributes of weight-loss devices in this study. We developed a tool to estimate the minimum weight loss acceptable by a patient to receive a device with a given risk profile and the maximum mortality risk tolerable in exchange for a given weight loss. For example, to accept a device with 0.01 % mortality risk, a risk tolerant patient will require about 10 % total body weight loss lasting 5 years.

Conclusions: Patient preference evidence was used make regulatory decision making more patient-centered. In addition, we captured the heterogeneity of patient preferences allowing market approval of effective devices for risk tolerant patients. CDRH is using the study tool to define minimum clinical effectiveness to evaluate new weight-loss devices. The methods presented can be applied to a wide variety of medical products. This study supports the ongoing development of a guidance document on incorporating patient preferences into medical-device premarket approval decisions.

Keywords: Benefit-risk assessment; FDA; Obesity treatment; Patient preferences; Regulatory-approval decisions; Weight-loss devices.

MeSH terms

Bariatric Surgery / instrumentation*
Choice Behavior
Cross-Sectional Studies
Decision Making*
Government Regulation*
Humans
Obesity / surgery
Patient Preference*
Risk Assessment
Surveys and Questionnaires
United States
United States Food and Drug Administration