Posted on Monday, April 23rd, 2012 Filed Under: eHealth Initiative

House of Reps Subcommittee Considers Reauthorization of MDUFA and PDUFA

On April 18, the House of Representatives Committee on Energy and Commerce, Subcommittee on Health held a hearing on draft legislation reauthorizing the FDA to collect “user fees” from pharmaceutical companies and medical device manufacturers seeking approval for new drugs and devices. The user fees, last authorized in FY 2008, provide an important source of funding for the FDA to review and approve applications in an expeditious manner. The draft legislative package also contains legislation authorizing the collection of user fees for generics and biosimilars and provisions to support the discovery pediatric pharmaceutical and antibiotics discovery, regulation of the pharmaceutical supply chain, and FDA’s ability to alleviate drug shortages, among others. Panelists were Dr. Janet Woodcock (FDA), Dr. Jeffrey Shuren (FDA), Dr. David Wheadon (PhRMA), Sara Radcliffe (BIO), Dr. David Gaugh (Generic Pharmaceutical Association), Joseph Levitt (on behalf of Advanced Medical Technology Association), and Allan Coukell (Pew).

The hearing itself was largely divided between the pharmaceutical industry and PDUFA (Prescription Drug User Fee Act) and medical devices and MDUFA (Medical Device User Fee Act). Dr. Woodcock fielded questions about PDUFA and issues such as: FDA’s regulation of the pharmaceutical supply chain (e.g. inspection of overseas manufacturing, counterfeit drugs), FDA’s response to drug shortages, and how to encourage development of new antibiotics and drugs for rare diseases.

Dr. Shuren handled questions about MDUFA and medical devices. While most questions were focused on broader concerns about the approval pathways for medical devices and whether or not they burdened manufacturers, members of the subcommittee also asked a number of questions regarding FDA’s regulation of medical software and mobile applications. Dr. Shuren noted that FDA is trying to remain sensitive to technological advances by opting not to exercise its regulatory authority broadly. Instead, FDA will continue to issue specific guidance to industry indicating in which cases and how extensively it will regulate medical software. For example, FDA has committed to regulating software that can impact patient safety at the point of care, such as an app that functions to turn a cell phone into a mobile ECG or one that receives and transmits information about a patient’s vital signs broadcast wirelessly by an implantable device.

Dr. Shuren indicated that changes to medical devices and software will only require reapproval from the FDA if they affect patient safety, effectiveness of the device, or represent a major technological advance. This way, regular software updates will not require reapproval, reflecting FDA’s understanding of the rapid innovation software often undergoes, even while on the market. Further, Dr. Shuren implied that the FDA would not like to see statutory changes to the definition of medical devices, preferring instead to use the agency’s discretion.

More information, including the testimony of the panelists, can be found on the subcommittee’s website.


Posted on Monday, April 16th, 2012 Filed Under: eHealth Initiative

Defining Value in Cancer Care

On April 12, 2012, Health Affairs held a public briefing on value in cancer care. At the briefing, a series of experts presented articles included in the April edition of the journal. The program included discussion of topics such as:

  • The value that patients place on hope during care
  • Consumer willingness to pay more for insurance to cover high-cost cancer drugs with a low chance of being needed
  • The use of both necessary and unnecessary imaging is often based on region
  • When considering additional survival time, price has a less than expected impact on whether a provider prescribes a cancer drug
  • Self-referral for in-house imaging/testing may lead to overuse of services
  • Newer, high-cost interventions may not offer greater benefits, yet are increasingly common
  • Gaps between patient preferences and provider recommendations at end of care

The briefing presented a host of different factors that compound our assessment of what cancer treatment is worth and how to pay for it. Patients place a great deal of value on intangible factors, like the hope that they will be one of the lucky few with better outcomes for a given treatment, even if the chance is small. At the same time other patients, particularly at the end of care, may prefer a palliative approach rather than intensive treatment. Similarly, treatment options often have hidden costs that complicate their use. For example, robotic surgery and the use of Intensity-Modulated Radiotherapy and Proton-beam Radiation have become more common despite their high price-tag, yet benefits are inconclusive.

As a result, panelists reminded the audience that evaluating cancer care is not as straight-forward as assessing the dollar-cost of treatment or adding a few more months to a patient’s life. Patient preferences must be better incorporated along the entire care spectrum. Hospitals, providers, researchers, and the pharmaceutical industry should emphasize post-market surveillance and comparative effectiveness research for oncology drugs and other clinical interventions to continuously evaluate efficacy and help cut costs. Clinical guidelines, developed by specialists, informed by real-world data, and updated regularly, can also help improve care.


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