French evaluation of innovative health technologies: Early access and fundings

To accelerate the availability of innovative healthcare technologies for patients with the potential for significant clinical benefits in a context of high unmet needs, derogatory programs have been elaborated. The aim of this paper is to describe the different pathways developed in France to accelerate access to innovation, efficiently handle uncertainties while controlling the risks for patients.

We first describe the different early and temporary accesses to innovation in France involving the HAS. Feedback on these pathways based on the decisions provided by the HAS up until June 2024, is summarised and discussed. Subsequent emphasis is placed on the challenges of the evaluation process.

French derogatory pathways for innovation distinguish between medicinal products, medical devices (MDs) and procedures, as well as the funding mechanism. Early funding is dedicated to MDs, in vitro diagnostic MDs and procedures. Later fast-track access is dedicated to medicinal products but also to (digital) MDs. Based on the submitted files from 2015 to 2021, the derogatory access was approved about 70% for medicinal products and 30% for MDs/procedures.

While fast-track processes appear widely used and understood for medicinal products, the different pathways available for MDs and procedures remain under-used and sometimes misunderstood. Whichever the product, the main limitation factor of approval was data quality and maturity, in concordance with reports on accelerated approvals from the FDA. The main challenge is to find the right balance between rapid access to innovation and patient safety, while addressing ethical challenges posed by new therapeutic approaches.