The Atlantic Divide in Coronary Heart Disease: Health Technologies Use in the Us and Portugal

Coronary heart disease (CHD) treatment has seen significant improvements due to new health technologies (HT) in interventional cardiology. Health systems (HS) adopt new HT at different speed and use rates, which may become more apparent when contrasting between HS with distinct features. We characterized and compared the ability of the HS of United States (US) and Portugal (PT) to access and use new HT to treat CHD. A total of 30 HT between January 1980 and February 2015, including medical devices and active substances, were identified by experts and reviewed. Approval/commercialization dates of the first medical devices models and active substances brands were abstracted using databases at the local regulatory agencies and complemented with other sources of information when necessary. Differences between dates were used for comparison between countries. We additionally performed an extensive literature review and retrieved information on use trends of these HT in PT versus US. Most medical devices reviewed were approved earlier in PT than in US (median time difference: 27 months), whereas drugs were more readily available in US (median time difference: 61 months). Furthermore, while all HT are currently approved in PT, the drug-eluting balloon, Nicorandil and Ivabradine lack approval in US. Utilization patterns vary across devices but evidence suggests that adoption in PT is sometimes deferred from approval and that the US generally reaches similar or higher utilization rates than PT. Commercialization of drugs in PT was delayed by a median of 65 months from approval. Regulatory mechanisms of approval and price controls are determinant in the type of HT available. However, other factors appear to play an important role in the diffusion of new HT. Differences in use could be explored for mutual benefit for assessing and monitoring safety and cost-effectiveness of HT between the two HS.