Post-Market Clinical Follow-up Case Study: Cook Medical
Background
Medical device manufacturers–with the involvement of notified bodies–must declare compliance, for both new and established products, to the applicable requirements of the EU MDR. EU MDR post-market requirements involve the continuous collection of clinical data, and evaluation of safety and performance after a device has been placed on the market. Manufacturers are required to develop and implement a post-market clinical follow-up (PMCF) plan as part of their post-market surveillance (PMS) program. PMCF is the proactive collection of clinical data, and activities may include:
- Prospective or retrospective clinical studies
- Patient registries
- Surveys
- Analysis of real-world data
A medium-sized retrospective chart review for 150 patients, across 3-4 sites, could easily cost upwards of $400,000 USD and require 12-18 months of time to complete. This is untenable as a long-term PMCF strategy for many product portfolios.
Project Description
3Aware engaged with Cook Medical, a major U.S.-based medical device manufacturer with an extensive portfolio developed over 60+ years, on a PMCF project for their Instinct PlusTM device. The device is used in the gastrointestinal tract, for the purposes of: 1) endoscopic marking, 2) hemostasis for mucosal and submucosal defects less than 3 cm, bleeding ulcers, arteries less than 2 mm, polyps less than 1.5 cm in diameter, diverticula in the colon, and prophylactic clipping to reduce the risk of delayed bleeding post lesion resection, 3) anchoring to affix jejunal feeding tubes to the wall of the small bowel, 4) as a supplemental method for closure of GI tract luminal perforations less than 20 mm that can be treated conservatively, and 5) anchoring to affix fully covered esophageal self-expanding metal stents to the wall of the esophagus in patients with fistulas, leaks, perforations, or disunion.
Previously, Cook Medical executed a PMCF activity for the InstinctTM Endoscopic Clipping Device via a retrospective chart review. For this round of PMCF activity with the second generation InstinctTM device, Cook Medical utilized the 3Aware aiSurveillance platform to gather clinical data covering a wide breadth of uses.
Introduction to aiSurveillance
aiSurveillance™ is a new approach to post-market surveillance combining data science and clinical science, developed specifically for the MedTech industry. aiSurveillance™ software integrates real-world data (RWD) sources, such as EHRs and inventory management systems. The software processes vast amounts of patient data, transforming the data into easily assessed patient outcome information from which reliable and actionable insights can be discovered. These RWE insights, available to MedTech at a fraction of the time and cost of other RWE methods, drive timely clinical and strategic product decisions.
Results & Conclusion
With the aiSurveillance™ platform, along with 3Aware clinical scientist support, the Cook Medical team successfully collected data on each indication. 3Aware aiSurveillance uncovered safety and performance data consistent with published prospective studies. Access to unstructured physician notes provided clarity regarding potential complications, adverse device effects and performance failures and prevented misidentification of indication.
Compared to the traditional retrospective chart review used for the predecessor InstinctTM device PMCF study, Cook Medical saved 60% in overall time, including nearly 50% savings in FTE hours, using 3Aware *aiSurveillance*.
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