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burdle
08-02-2017, 07:18 AM
I thought the FDA was analogous to NICE in UK.

However I have read that the FDA does not actually approve surgical procedure but only the 'devices' used in such procedures.


I think NICE actually approves the surgery also.

Can anyone clarify for me?

titaniumed
08-02-2017, 09:13 PM
Burdle, The FDA will approve of something like Infuse kits (BMP), but only if trained in its usage, and particular procedure. If used in any other procedure that's not recommended or approved, its considered "off label". Surgeons are allowed to do "off label" procedures before the FDA gives a green light. (Tethering is a good example)(Magec is a good example) Surgeons need to be trusted that they are doing what they feel will benefit a patient, should something go wrong and end up in a courtroom, its mainly about intent. I signed a few waivers stating that I was informed of discussed complications of my procedure.

So, a product approved with stipulations, but no control over its usage. BMP is approved for ALIF surgery only in scoliosis surgery. Not for posterior procedures.

Its a good idea to know if you are having an off label procedure.

Agreements and confidentiality between MHRA -FDA
https://www.fda.gov/InternationalPrograms/Agreements/ConfidentialityCommitments/ucm100084.htm

Its a mountain of material.

Ed

burdle
08-03-2017, 05:37 AM
Thanks Ed,

In UK we have NATIONAL INSTITUTE OF CLINICAL EXCELLENCE. But this body 'regulates' procedures. The remit is are they 'cost effective'- it is a different perspective

I guess from an FDA point of view you cant do a procedure if there are no devices that have been approved for it ( notwithstanding 'off-label). In UK Tethering is not on the table because of NICE but it is the procedure itself. However if/when it is approved it will have to be with the use of certain devices. I need to find out how devices get approved in UK