In 1976, a fast-track pathway to approval for new medical devices was approved by Congress. This pathway, called the 510(k) process, allows device manufacturers to get their products to market sooner by showing the U.S. Food and Drug Administration that their devices are substantially similar to devices that have already been approved for market. Unfortunately, some of those previously approved devices, called predicate devices, are decades old and some are no longer on the market.
Approval Overhaul Planned
The FDA released a statement on November 26, 2018, announcing it was going to modernize the 510(k)-approval pathway in an effort to keep pace with the evolution of technology. The agency said that new medical devices seeking approval would need to show the devices meet modern performance and safety rules. At the same time, the watchdog agency will be retiring outdated predicate devices when technologies emerge that are safer and more effective.
The agency is also updating the framework of the approval pathway. In 2017, the FDA approved 3,173 devices, or about 82 percent of the total number of devices cleared, through the 510(k) program. The agency has proposed to tighten cut-off criteria for predicate comparisons to ten years, which means that when manufacturers apply for approval, they will have to show their device is substantially similar in safety and efficacy as a modern device, not decades old devices.
The goal is to eventually force companies to base their new products on devices that have been on the market for less than 10 years, and the agency is considering whether to publicly list devices and makers who based their products on devices that are older than 10 years.
Not everyone is behind the approval process overhaul, including the lobbying group for the industry, Advanced Medical Technology Association. The CEO of the group said that cutting out devices that are older than a decade may ‘prove arbitrary’ as those older devices carry with them extensive performance data.
Investigations Suggest High Failure Rates with Quick-Cleared Devices
While the FDA said it has been considering and planning an overhaul for a long time, the announcement came after a large group of investigative journalists and news outlets published a year-long investigation into medical device failures. The investigation seriously questions the 510(k)-approval process whether problems could be missed that put patients at risk. The investigation names products tied to large numbers of injury reports filed with the FDA including spinal stimulators, hip implants, surgical mesh, implanted insulin pumps, and defibrillators. The investigative journalists suggest that while the FDA can speed a device through the approval process, it rarely pulls devices from the market, and when it does, it can take years.
The FDA reports that it clears or approves for market about a dozen devices every day and that the few devices that do get media attention are fewer than the number that is released to the market on an average day.
The FDA expects to implement the changes in early 2019.