Discussion

Microsystems technology is nowadays playing a major role for improving products in the health care sector. In the last years, the development of MST applications has been boosted by the ability to manufacture MST elements with high precision, reliability, and at acceptable costs. A considerable number of products used in clinical routine today are functionally based on MST and allied technologies.

These applications include the medical high volume markets of cardiac rhythm management [28] or implantable hearing aids [5], as well as highly specialized applications in the field of neural rehabilitation [23].

Rebello [17] has identified a minimum of 25 major research programs internationally, focusing only on surgical MST and surgical sensors. This shows there are major research efforts in progress that will deliver further leads for device companies to develop advanced medical products on the basis of MST.

The world market projection for MST and MST components in medical products was expected to exceed $1 billion by 2005 or 2006. This considerable market potential will attract more industrial players to invest into microtechnology for medical and surgical products.

The clinical foundation for promoting the use of MST in medicine is mainly based on the significant potential of MST to enable products that improve early disease detection and the monitoring of chronic illnesses. This refers to a number of the most important health problems such as cardiovascular disease, hypertension, diabetes, and cancer, to name just a few. The possibility to provide better diagnostic techniques based on microstructures, such as confocal fluorescence microscopy [8] may significantly improve the efficiency of early cancer detection programs.

Besides the future advantages for the diagnostic precision and diagnostic quality, MST can also deliver advantages directly to the patient. In the field of self-propelled endoscopy [16], MST components play an important role in reducing the forces that are exerted to the tissue. The reduction of force will directly address pain and discomfort during cancer screening colonos-copy, thus improving the willingness of individuals to attend a cancer prevention program.

In addition to the significant opportunities that MST brings for innovating medical devices, there are also several particular challenges that need to be addressed. One of the key hurdles for using MST more widely in medical products is the enormous cost involved into the development and the design of MST components. In large industrial applications, this cost is offset against high production volumes. In many specialized medical applications, however, production volumes are relatively small compared with industrial dimensions.

Increasing standardization of MST components may help to solve this problem. Similar to electronics, where well-defined standardized components are available at low cost, standardized MST components such as pressure sensors, telemetry units, or optical structures not dedicated to a single application but for multiple purposes will become available. To achieve this goal, it is important to formulate and respect technical standards [15].

But there are also a number of nontechnical problems for MST that need to be overcome. Among the most important barriers to innovation seen by specialists from the field are unclear reimbursement conditions [10]. This shows that the further progress MST in medicine not only depends on successful R&D and the establishment of technical standards, but also on the availability of innovative reimbursement schemes that act as incentives for the use of advanced technology, particularly in the areas of disease prevention and early detection. Especially in these fields can innovation provide a significant leverage on reducing healthcare costs in the mid and long term. This needs to be reflected in reimbursement for medical care enabled by MST or other advanced technologies.

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