Humanitarian Device Exemption

Humanitarian Device Exemption (HDE) is a regulatory pathway established by the United States Food and Drug Administration (FDA) for medical devices that address the needs of patients with rare conditions or diseases affecting fewer than 8,000 individuals in the United States per year. The HDE is designed to encourage the development and availability of medical devices for these small patient populations by providing a streamlined regulatory process. This exemption allows for the marketing of such devices without requiring evidence of effectiveness that would be needed for a traditional premarket approval (PMA).

Overview

The HDE pathway was created under the Safe Medical Devices Act of 1990 and later amended by the Food and Drug Administration Modernization Act of 1997. It is intended to facilitate the development of medical devices that may have a significant, positive impact on the health and quality of life for patients with rare diseases or conditions, for which no comparable devices are available.

To qualify for an HDE, a device must meet several criteria:

• It must be intended to treat or diagnose a disease or condition that affects or is manifested in fewer than 8,000 individuals in the United States per year.
• There must be no comparable devices available to treat or diagnose the condition.
• The device's development must be for the benefit of patients who would otherwise not have other means of treatment or diagnosis.
• The applicant must demonstrate that the probable benefit to health outweighs the risk of injury or illness from its use, and that the device will not expose patients to an unreasonable or significant risk of illness or injury.

Application Process

The application process for an HDE is similar to that of a PMA but with some key differences. The most notable difference is that the manufacturer is not required to provide the results of clinical trials demonstrating the effectiveness of the device, though safety data are still required. Instead, the application must include evidence that the device has undergone appropriate testing to ensure its safety and that its probable benefits outweigh the risks.

Regulatory Considerations

Once an HDE is granted, the device can be marketed in the United States. However, there are several important considerations:

• The device may only be used in facilities that have established local institutional review board (IRB) oversight for its use.
• The device cannot be sold for an amount that exceeds the costs of research and development, fabrication, and distribution.
• The FDA may place other conditions on the approval, including post-market surveillance, to monitor the safety and effectiveness of the device.

Challenges and Limitations

While the HDE pathway provides a valuable avenue for the development and availability of medical devices for rare conditions, there are challenges and limitations. The limited market size for such devices can deter manufacturers from pursuing an HDE due to the potential for limited financial return. Additionally, the requirement for IRB oversight in each facility can complicate the process of implementing the use of the device across multiple locations.

Conclusion

The Humanitarian Device Exemption represents a critical regulatory pathway for medical devices intended to treat or diagnose rare diseases or conditions. By providing a streamlined process for approval, the HDE facilitates the availability of potentially life-saving or life-enhancing devices to small patient populations that would otherwise have limited options.