Drug Disinvestment Frameworks: Components, Challenges, and Solutions

Maloney, Mary Alison; Schwartz, Lisa; O’Reilly, Daria; Levine, Mitchel

doi:10.1017/s0266462317000277

Cited by 17 publications

(37 citation statements)

References 27 publications

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“…Disinvested technologies have comprised obsolete/abandoned and/or unsafe technologies. This terminology is similar to that of other studies, acknowledging that many different terms have been used to describe disinvestment, making this a challenging area across countries [ 2 – 5 ].…”

Section: Introductionmentioning

confidence: 94%

“…The negative side of this approach is the time needed to generate the evidence and the timing of the decisions. Studying the performance of health technologies in the real world takes time and resources, both of which may hamper disinvestment decisions, as seen in other disinvestment attempts worldwide [ 2 ]. This motivated CONITEC to embrace a wider strategy in which prioritised technologies will be assessed for performance for continued investment, probably using partner research centres and funds already available for research of interest to SUS.…”

Section: Overview Of Disinvestment Processmentioning

confidence: 99%

“…Consequently, this paper presents a summary of the detail disinvestment process of IFN-β-1a-IM for treatment of MS in Brazil and CONITEC’s final recommendation following identification as a potential disinvestment opportunity. This builds on the recently agreed process for disinvestment decisions in Brazil [ 7 ], as well as recent systematic and other reviews in the area of disinvestment [ 2 – 5 ]. We believe these activities will be of interest to other governments and agencies seeking to instigate disinvestment of less effective and/or less valued technologies as they strive to provide universal healthcare with finite resources.…”

Section: Introductionmentioning

confidence: 99%

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The Assessment for Disinvestment of Intramuscular Interferon Beta for Relapsing-Remitting Multiple Sclerosis in Brazil

et al. 2017

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In Brazil, inclusion and exclusion of health technologies within the Unified Health System (SUS) is the responsibility of the National Committee for Health Technology Incorporation (CONITEC). A recent Cochrane systematic review demonstrated that intramuscular interferon beta 1a (IFN-β-1a-IM) was inferior to the other beta interferons (IFN-βs) for multiple sclerosis (MS). As a result, CONITEC commissioned an analysis to review possible disinvestment within SUS. The objective of this paper is to describe the disinvestment process for IFN-β-1a-IM in Brazil. The first assessment comprised a literature review and mixed treatment comparison meta-analysis. The outcome of interest was the proportion of relapse-free patients in 2 years. This analysis confirmed the inferiority of IFN-β-1a-IM. Following this, CONITEC recommended disinvestment, with the decision sent for public consultation. More than 3000 contributions were made on CONITEC’s webpage, most of them against the preliminary decision. As a result, CONITEC commissioned a study to assess the effectiveness of IFN-β-1a-IM among Brazilian patients in routine clinical care. The second assessment involved an 11-year follow-up of a non-concurrent cohort of 12,154 MS patients developed by deterministic-probabilistic linkage of SUS administrative databases. The real-world assessment further demonstrated that IFN-β-1a-IM users had a statistically higher risk of treatment failure, defined as treatment switching or relapse treatment or death, with the assessment showing that IFN-β-1a-IM was inferior to the other IFN-βs and to glatiramer acetate in both direct and indirect analysis. In the drug ranking with 40,000 simulations, IFN-β-1a-IM was the worst option, with a success rate of only 152/40,000. Following this, CONITEC decided to exclude the intramuscular presentation of IFN-β from the current MS treatment guidelines, giving patients who are currently on this treatment the option of continuing until treatment failure. In conclusion, we believe this is the first example of this new disinvestment process in action, providing an exemplar for other treatments in Brazil as well as other countries.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-017-0579-0) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 94%

Section: Overview Of Disinvestment Processmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Assessment for Disinvestment of Intramuscular Interferon Beta for Relapsing-Remitting Multiple Sclerosis in Brazil

et al. 2017

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“…Furthermore, a lack of support from decision-makers has been described as a barrier to the implementation of disinvestment [17]. However, it has also been described in previous studies that obtaining support for disinvestment is very di cult as stakeholders often lack the will to support disinvestment because of limited perceived value of disinvestment, which may take some time to realize, and their resistance to immediately "losing" therapy options [12,35]. Hence, to make actors, especially healthcare providers and policymakers, aware of the value of disinvestment (e.g.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

What Influences the Outcome of Active Disinvestment Processes in Healthcare? A Qualitative Interview Study on five Recent Cases of Active Disinvestment

Rotteveel

Lambooij

Rijt

et al. 2020

Preprint

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Background: Recent attempts of active disinvestment (i.e. withdrawal of reimbursement by means of a policy decision) of reimbursed healthcare interventions in the Netherlands have differed in their outcome: some were successful, with interventions actually being disinvested, while others were terminated at some point, implying continuation of reimbursement. This study aimed to obtain insight into recent active disinvestment processes, and to explore what aspects affect their outcome.Methods: Semi-structured interviews were conducted from January to December 2018 with stakeholders (e.g. patients, policymakers, physicians) who were involved in the policy process of five cases for which the full or partial withdrawal of reimbursement was considered in the Netherlands between 2007 and 2017: benzodiazepines, medication for Fabry disease, quit smoking programme, psychoanalytic therapy and maternity care assistance. These cases covered both interventions that were eventually disinvested and interventions for which reimbursement was maintained after consideration. Interviews were transcribed verbatim, double coded and analyzed using thematic analysis.Results: The 37 interviews showed that support for disinvestment from stakeholders, especially from healthcare providers and policymakers, strongly affected the outcome of the disinvestment process. Furthermore, the institutional role of stakeholders as legitimized by the Dutch health insurance system, their financial interests in maintaining or discontinuing reimbursement, and the possibility to relieve the consequences of disinvestment for current patients affected the outcome of the disinvestment process as well. No evidence was found of a consistent role of the formal Dutch package criteria (i.e. effectiveness, cost-effectiveness, necessity and feasibility) in active disinvestment processes.Conclusions: Contextual factors as well as the possibility to relieve the consequences of disinvestment for current patients are important determinants of the outcome of active disinvestment processes. These results provide insight into active disinvestment processes and their determinants, and provide guidance to policymakers for a potentially more successful approach for future active disinvestment processes.

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“…Within the decision dissemination component, both passive (such as posting recommendations on a website) (5) and active (such as point-of-care decision support tools) (6) dissemination strategies have been proposed (7). Despite growing interest in the HTR eld, implementation challenges of its outputs continue to exist (4,6,8).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Knowledge Translation Theories, Models and Frameworks for Health Technology Reassessment: Expert Perspectives Through a Qualitative Exploration

Esmail

Clement

Holroyd‐Leduc

et al. 2020

Preprint

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Background: Health Technology Reassessment (HTR) is a process that systematically assesses technologies that are currently used in the health care system. The process results in four outputs: increase use or decrease use, no change, or de-adoption of a technology. Implementation of these outputs remains a challenge. The Knowledge Translation (KT) field enables knowledge into practice. KT could help with implementation of HTR outputs. This study sought to identify which characteristics of KT theories, models, and frameworks (TMFs) could be useful, specifically for decrease use or de-adoption of a technology.Methods: A qualitative descriptive approach was used to ascertain the perspectives of international KT and HTR experts on the characteristics of KT TMFs for decrease use or de-adoption of a technology. One-to-one semi-structured interviews were conducted from September to December 2019. Interviews were audio recorded and transcribed verbatim. Themes and sub-themes were deduced from the data through framework analysis using five distinctive steps: familiarization, identifying an analytic framework, indexing, charting, mapping and interpretation. Themes and sub-themes were also mapped to existing KT TMFs.Results: Thirteen individuals from Canada, United States, United Kingdom, Australia, Germany, Spain, and Sweden participated in the study. Three themes emerged that illustrated the ideal traits of a KT TMF: principles that were foundational for HTR, levers of change, and steps for knowledge to action. Principles included evidence-based, high usability, patient-centered, and ability to apply to the micro, meso, macro levels. Levers of change were characterized as positive, neutral, or negative influences for changing behaviour for HTR. Steps for knowledge to action included: build the case for HTR, adapt research knowledge, assess context, select, tailor and implement interventions, and assess impact. Of the KT TMFs that were mapped, the Consolidated Framework for Implementation Research had most of the characteristics, except ability to apply to micro, meso, macro levels. Conclusions: Application of KT TMFs to HTR has not been clearly understood. Characteristics that need to be considered within a KT TMF for implementing HTR outputs have been identified. Consideration of these characteristics within KT TMFs may guide users undertaking HTR projects.

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Drug Disinvestment Frameworks: Components, Challenges, and Solutions

Cited by 17 publications

References 27 publications

The Assessment for Disinvestment of Intramuscular Interferon Beta for Relapsing-Remitting Multiple Sclerosis in Brazil

The Assessment for Disinvestment of Intramuscular Interferon Beta for Relapsing-Remitting Multiple Sclerosis in Brazil

What Influences the Outcome of Active Disinvestment Processes in Healthcare? A Qualitative Interview Study on five Recent Cases of Active Disinvestment

Characteristics of Knowledge Translation Theories, Models and Frameworks for Health Technology Reassessment: Expert Perspectives Through a Qualitative Exploration

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