Impact of Guidelines on the Diffusion of Medical Technology: A Case Study of Cardiac Resynchronization Therapy in the UK
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ORIGINAL RESEARCH ARTICLE
Impact of Guidelines on the Diffusion of Medical Technology: A Case Study of Cardiac Resynchronization Therapy in the UK Rucha Vadia1,2 · Tom Stargardt1 Accepted: 2 September 2020 © The Author(s) 2020
Abstract Introduction Research on clinical practice guidelines as a determinant of the diffusion of medical technology remains sparse. We aim to evaluate the impact of guidelines on the awareness of medical technology, as a proxy of its use, with the example of cardiac resynchronization therapy (CRT) in the United Kingdom (UK). Methods We measured clinician awareness based on Google searches performed for CRT that corresponded with actual CRT implant numbers provided by the European Heart Rhythm Association (EHRA). We identified the guideline recommendations published by the National Institute of Health and Care Excellence (NICE) within the UK, the European Society of Cardiology (ESC) at the European level, and the American College of Cardiology Foundation/American Heart Association in the United States (US). We specified a dynamic moving average model, with Google searches as the dependent variable and guideline changes as the independent variables. Results One guideline change published by NICE in 2007 and two changes released by the US guidelines in 2005 and 2012 were significantly correlated with the Google searches (p = 0.08, p = 0.02, and p = 0.02, respectively). Guideline changes by the ESC had no significant impact. Changes recommending CRT in place of a conventional pacemaker, in patients with atrial fibrillation, and restricting CRT due to contraindication, remained universally uninfluential. Conclusion The factors associated with a lack of awareness (as a proxy for technology diffusion) in our case study were: a lack of strong clinical evidence that resulted in the moderate strength of a recommendation, a lack of recognition of any externally published recommendation by NICE, and the frequent release of guidelines with minor changes targeting small patient groups. At least in our case, in the absence of NICE guidelines, the US guidelines received more attention than their non-UK European counterparts, even if the former were released after the latter.
Key Points for Decision Makers Awareness—and thus presumably use of—CRT in the UK is associated with one NICE guideline from 2007 and two US guidelines from 2005 and 2012.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40258-020-00610-8) contains supplementary material, which is available to authorized users. * Rucha Vadia [email protected]; rucha.vadia@uni‑hamburg.de 1
Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
Abbott, Health Economics & Reimbursement, Da Vincilaan 11, 1935 Zaventem, Belgium
2
Strong clinical evidence, reflected by the strength of guideline recommendation, seems to be important for clinician response to the guideline. When national guidelines were absent, the US guidelines rather than th
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