Disinvestment in healthcare: a scoping review of systematic reviews

Kamaruzaman, Hanin Farhana; Grieve, Eleanor; Wu, Olívia

doi:10.1017/s0266462322000514

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…83) [ 5 ]. However, removing a technology that is already established in clinical practice is usually faced with resistance from relevant stakeholders [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Utilization of innovative medical technologies in German inpatient care: does evidence matter?

Eckhardt,

Felgner,

Dreger

et al. 2023

Health Res Policy Sys

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Background The reimbursement of new technologies in inpatient care is not always linked to a requirement for evidence-based evaluation of patient benefit. In Germany, every new technology approved for market was until recently eligible for reimbursement in inpatient care unless explicitly excluded. The aim of this work was (1) to investigate the type of evidence that was available at the time of introduction of 25 innovative technologies and how this evidence evolved over time, and (2) to explore the relationship between clinical evidence and utilization for these technologies in German inpatient care. Methods This study combined different methods. A systematic search for evidence published between 2003 and 2017 was conducted in four bibliographic databases, clinical trial registries, resources for clinical guidelines, and health technology assessment—databases. Information was also collected on funding mechanisms and safety notices. Utilization was measured by hospital procedures captured in claims data. The body of evidence, funding and safety notices per technology were analyzed descriptively. The relationship between utilization and evidence was explored empirically using a multilevel regression analysis. Results The number of included publications per technology ranges from two to 498. For all technologies, non-comparative studies form the bulk of the evidence. The number of randomized controlled clinical trials per technology ranges from zero to 19. Some technologies were utilized for several years without an adequate evidence base. A relationship between evidence and utilization could be shown for several but not all technologies. Conclusions This study reveals a mixed picture regarding the evidence available for new technologies, and the relationship between the development of evidence and the use of technologies over time. Although the influence of funding and safety notices requires further investigation, these results re-emphasize the need for strengthening market approval standards and HTA pathways as well as approaches such as coverage with evidence development.

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“…83) [ 5 ]. However, removing a technology that is already established in clinical practice is usually faced with resistance from relevant stakeholders [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Utilization of innovative medical technologies in German inpatient care: does evidence matter?

Eckhardt,

Felgner,

Dreger

et al. 2023

Health Res Policy Sys

View full text Add to dashboard Cite

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“…As HTA is mostly used for new investments and single technology appraisals, it has been found to be more challenging to apply as a disinvestment framework [ 79 ]. A scoping review on disinvestment (under review) [ 80 ] identifies HTA/HTR and PBMA as the most common methods used to assess potential candidates for disinvestment, with most disinvestment initiatives implemented in HIC and UMIC. Given the current climate, if countries are unable to spend more, they need to spend better.…”

Section: Future Directionsmentioning

confidence: 99%

How Least Developed to Lower-Middle Income Countries Use Health Technology Assessment: A Scoping Review

Falkowski

Ciminata

Manca

et al. 2022

Pathogens and Global Health

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Health Technology Assessment (HTA) is a multidisciplinary tool to inform healthcare decision-making. HTA has been implemented in high-income countries (HIC) for several decades but has only recently seen a growing investment in low- and middle-income countries. A scoping review was undertaken to define and compare the role of HTA in least developed and lower middle-income countries (LLMIC). MEDLINE and EMBASE databases were searched from January 2015 to August 2021. A matrix comprising categories on HTA objectives, methods, geographies, and partnerships was used for data extraction and synthesis to present our findings. The review identified 50 relevant articles. The matrix was populated and sub-divided into further categories as appropriate. We highlight topical aspects of HTA, including initiatives to overcome well-documented challenges around data and capacity development, and identify gaps in the research for consideration. Those areas we found to be under-studied or under-utilized included disinvestment, early HTA/implementation, system-level interventions, and cross-sectoral partnerships. We consider broad practical implications for decision-makers and researchers aiming to achieve greater interconnectedness between HTA and health systems and generate recommendations that LLMIC can use for HTA implementation. Whilst HIC may have led the way, LLMIC are increasingly beginning to develop HTA processes to assist in their healthcare decision-making. This review provides a forward-looking model that LLMIC can point to as a reference for their own implementation. We hope this can be seen as timely and useful contributions to optimize the impact of HTA in an era of investment and expansion and to encourage debate and implementation.

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Evidence is not enough: health technology reassessment to de-implement low-value care

Ingvarsson,

Hasson,

von Thiele Schwarz

et al. 2024

Health Res Policy Sys

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Background The use of low-value care (LVC) is a persistent challenge in health care. Health technology reassessment (HTR) assesses the effects of technologies currently used in the health care system to guide optimal use of these technologies. Consequently, HTR holds promises for identifying and reducing, i.e., de-implementing, the use of LVC. There is limited research on how HTR is executed to support the de-implementation of LVC and whether and how HTR outcomes are translated into practical application. The aim of this study is to investigate how HTR is conducted to facilitate de-implementation of LVC and to investigate how the results of HTR are received and acted on in health care settings. Methods This study is a qualitative interview study with representatives from health technology assessment agencies (n = 16) that support the regional health care organizations in Sweden and with representatives from the health care organizations (n = 7). Interviews were analysed with qualitative content analysis. Results We identified three overarching categories for how HTR facilitates de-implementation of LVC and how the results are received and acted on in health care settings: (1) involving key stakeholders to facilitate de-implementation of LVC in identifying potential LVC practices, having criteria for accepting HTR targets, ascertaining high-quality reports and disseminating the reports; (2) actions taken by health care organization to de-implement LVC by priority setting and decision-making, networking between health care organizations and monitoring changes in the use of LVC practices; and (3) sustaining use of LVC by not questioning continued use, continued funding of LVC and by creating opinion against de-implementation. Conclusions Evidence is not enough to achieve de-implementation of LVC. This has made health technology assessment agencies and health care organizations widen the scope of HTR to encompass strategies to facilitate de-implementation, including involving key stakeholders in the HTR process and taking actions to support de-implementation. Despite these efforts, there can still be resistance to de-implementation of LVC in passive forms, involving continued use of the practice and more active resistance such as continued funding and opinion-making opposing de-implementation. Knowledge from implementation and de-implementation research can offer guidance in how to support the execution phase of HTR.

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Disinvestment in healthcare: a scoping review of systematic reviews

Cited by 4 publications

References 30 publications

Utilization of innovative medical technologies in German inpatient care: does evidence matter?

Utilization of innovative medical technologies in German inpatient care: does evidence matter?

How Least Developed to Lower-Middle Income Countries Use Health Technology Assessment: A Scoping Review

Evidence is not enough: health technology reassessment to de-implement low-value care

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