Purchasing high-cost medical equipment in hospitals: A systematic review

Abstract

ABSTRACTObjectivesTo systematically review academic literature for empirical studies on any processes, procedures, methods or approaches to purchasing high-cost medical equipment within hospitals in high-income countries.DesignSystematic reviewMethodsOn 13 August 2020, we searched the following from inception: Cost-Effectiveness Analysis Registry, EconLit and ProQuest Dissertations & Theses A&I via ProQuest, Embase, MEDLINE, and MEDLINE in Process via Ovid SP, Google and Google Scholar, Health Management and Policy Database via Ovid SP, IEEE Xplore Digital Library, International HTA Database, NHS EED via CRD Web, Science Citation Index-Expanded, Conference Proceedings Citation Index-Science, and Emerging Sources Citation Index via Web of Science, Scopus, and Zetoc conference search. Studies were included if they described the approach to purchasing (also known as procurement or acquisition) of high-cost medical devices and/or equipment conducting within hospitals in high-income countries between 2000-2020. Studies were screened, data extracted, and summarised.ResultsOf 9437 records, 24 were included, based in 12 different countries and covering equipment types ranging from surgical robots to MRI scanners and orthopaedic implants. Study types included descriptions of processes taking place within or across hospitals (n=14), out of which three reported cost savings; empirical studies in which hospital records or participant data were analysed (n=8), and evaluations or pilots of proposed purchasing processes (n=2). Studies mainly highlight the importance of multidisciplinary involvement (especially clinical engineers and clinicians) in purchasing decision-making to balance technical, financial, safety and clinical aspects of device selection, and the potential of increasing evidence-based decisions using approaches ranging from hospital-based health technology assessments, ergonomics, to conducting user ‘trials’ of the device in use before purchase.ConclusionsWe highlight the lack of rigorous empirical work on this topic, calling for more intervention based and empirical work to advance the evidence base in this domain to advance knowledge, policy and practice.Strengths and limitations of this study-First systematic review of empirical work conducted in hospitals on purchasing of high-cost medical devices-Broad search covering a range of disciplines and study types-Limited to high-cost equipment which is challenging to differentiate across studies and has no standardised ‘value’ globally