Dutch Medicines Evaluation Board (CBG-MEB), Utrecht, The Netherlands.
Department of Pharmacology and Toxicology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Expert Rev Mol Diagn. 2022 May;22(5):583-590. doi: 10.1080/14737159.2022.2087508. Epub 2022 Jun 14.
The In Vitro Diagnostics Regulation 2017/746 (IVDR) coming into force from May 2022, creates the first European regulatory recognition for biomarker tests linked to medicinal products, so-called companion diagnostics (CDx). Since the introduction of the IVDR is associated with uncertainties about its impact on hospital practice, it is urgent and valuable to investigate how and why CDx are currently used in hospital practice, which factors influence the choice for applying in-house or commercial CDx, and what the expectations are about how the IVDR may affect current practice.
We investigated these questions using an interview-based approach and focused on 15 hospital laboratories in the Netherlands, including 7 academic and 8 general hospitals. All types of CDx were considered relevant for this research, including both genetic and protein-based biomarkers.
Factors found included: costs and convenience, complexity of application, and compatibility with existing workflows. Next to in-house and commercial CDx, hospital laboratories addressed compatibility by tweaking existing CDx.
Although increased quality of CDx is welcomed, worries toward increased costs and administrative work, and decreased quality were expressed. Further, the IVDR might also hinder using optimized in-house and tweaked CDx. Additionally, increased administrative burden could decrease innovativeness toward CDx.
2017 年 5 月生效的《体外诊断法规 2017/746(IVDR)》为与药品相关的生物标志物检测(即所谓的伴随诊断(CDx))创建了首个欧洲监管认可。由于 IVDR 的引入伴随着对其对医院实践影响的不确定性,因此迫切需要调查目前 CDx 在医院实践中是如何以及为何被使用的,哪些因素影响了选择使用内部或商业 CDx,以及对 IVDR 可能如何影响当前实践的期望。
我们使用基于访谈的方法调查了这些问题,并将重点放在荷兰的 15 个医院实验室,包括 7 个学术医院和 8 个综合医院。所有类型的 CDx 都被认为与这项研究相关,包括基于遗传和蛋白质的生物标志物。
发现的因素包括:成本和便利性、应用的复杂性以及与现有工作流程的兼容性。除了内部和商业 CDx,医院实验室还通过调整现有的 CDx 来解决兼容性问题。
尽管增加 CDx 的质量受到欢迎,但也表达了对增加成本和行政工作以及降低质量的担忧。此外,IVDR 也可能阻碍使用优化的内部和调整的 CDx。此外,增加行政负担可能会降低对 CDx 的创新性。