Guiding the process of health technology disinvestment

Ibargoyen-Roteta, Nora; Gutiérrez-Ibarluzea, Iñaki; Asúa, José M.

doi:10.1016/j.healthpol.2010.06.018

Cited by 38 publications

(63 citation statements)

References 8 publications

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“…Australia has been moving forward to establish disinvestment at the local level by developing the Australasian Registry of Obsolete Health Technologies Evaluated for Disinvestment [7–9]. Spain has regulatory support on a national level, called the Royal Decree 1030 [10], while Osteba in the Basque area and the Galician Agency for Health Technology Assessment (Avalia-t) in the Galicia area play leading roles in HTR at the regional level [11, 12] (Table 2). …”

Section: Resultsmentioning

confidence: 99%

“…The decision-making results include eight possibilities: in favour of the proposal; against the proposal; against the proposal, but modifiable in the future; against the proposal because of a lack of evidence, but modifiable in the future; proposal recommended; proposal not recommended; proposal not recommended, but can be considered when the capacity of the centre has been revised; and proposal not recommended, but modifiable when new evidence is available [12]. Information asymmetry between clinically engaged experts and policy or decision makers may preclude the truly collaborative, informed and technical discussions required to generate genuine change.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review on current status of health technology reassessment: insights for South Korea

Seo

Park

Lee

2016

Health Res Policy Sys

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BackgroundTo systematically investigate the current status and methodology of health technology reassessment (HTR) in various countries to draw insights for the healthcare system in South Korea.MethodsA systematic literature search was conducted on the articles published between January 2000 and February 2015 on Medline, EMBASE, the Cochrane Library, CINAHL, and PubMed. The titles and abstracts of retrieved records were screened and selected by two independent reviewers. Data related to HTR were extracted using a pre-standardised form. The review was conducted using narrative synthesis to understand and summarise the HTR process and policies.ResultsForty five studies, conducted in seven countries, including the United Kingdom, Australia, Canada, Spain, Sweden, Denmark, and the United States of America, fulfilled the inclusion criteria. Informed by the literature review, and complemented by informant interviews, we focused on HTR activities in four jurisdictions: the United Kingdom, Canada, Australia, and Spain. There were similarities in the HTR processes, namely the use of existing health technology assessment agencies, reassessment candidate technology identification and priority setting, stakeholder involvement, support for reimbursement coverage, and implementation strategies. Considering the findings of the systematic review in the context of the domestic healthcare environment in Korea, an appropriate HTR model was developed. This model included four stages, those of identification, prioritisation, reassessment and decision.ConclusionsDisinvestment and reinvestment through the HTR was used to increase the efficiency and quality of care to help patients receive optimal treatment. Based on the lessons learnt from other countries’ experiences, Korea should make efforts to establish an HTR process that optimises the National Healthcare Insurance system through revision of the existing Medical Service Act.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A systematic review on current status of health technology reassessment: insights for South Korea

Seo

Park

Lee

2016

Health Res Policy Sys

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“…153,154 Others have proposed full-blown guidance on the entire process. 155 These suggestions remain untested, and disinvestment in practice remains an elusive subject. While disinvestment has featured within previous priority-setting programmes, these have been 'one off' exercises, usually introduced by researchers themselves.…”

Section: What Is Already Known About Disinvestment In Practice?mentioning

confidence: 99%

“…Academic commentators and experts in the field have suggested frameworks and models to guide disinvestment, although these remain untested. 152,155,[168][169][170] There is, however, a growing body of empirical evidence to aid in the identification of disinvestment candidates (e.g. looking at clinical practice variations).…”

Section: The Lack Of Tools and Guidance To Inform Disinvestmentmentioning

confidence: 99%

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Hollingworth

Rooshenas

Busby

et al. 2015

Health Services and Delivery Research

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BackgroundNHS expenditure has stagnated since the economic crisis of 2007, resulting in financial pressures. One response is for policy-makers to regulate use of existing health-care technologies and disinvest from inefficiently used health technologies. A key challenge to disinvestment is to identify existing health technologies with uncertain cost-effectiveness.ObjectivesWe aimed to explore if geographical variation in procedure rates is a marker of clinical uncertainty and might be used by local commissioners to identify procedures that are potential candidates for disinvestment. We also explore obstacles and solutions to local commissioners achieving disinvestment, and patient and clinician perspectives on regulating access to procedures.MethodsWe used Hospital Episode Statistics to measure geographical variation in procedure rates from 2007/8 to 2011/12. Expected procedure numbers for each primary care trust (PCT) were calculated adjusting for proxies of need. Random effects Poisson regression quantified the residual inter-PCT procedure rate variability. We benchmarked local procedure rates in two PCTs against national rates. We conducted rapid systematic reviews of two high-use procedures selected by the PCTs [carpal tunnel release (CTR) and laser capsulotomy], searching bibliographical databases to identify systematic reviews and randomised controlled trials (RCTs). We conducted non-participant overt observations of commissioning meetings and semistructured interviews with stakeholders about disinvestment in general and with clinicians and patients about one disinvestment case study. Transcripts were analysed thematically using constant comparison methods derived from grounded theory.ResultsThere was large inter-PCT variability in procedure rates for many common NHS procedures. Variation in procedure rates was highest where the diffusion or discontinuance was rapidly evolving and where substitute procedures were available, suggesting that variation is a proxy for clinical uncertainty about appropriate use. In both PCTs we identified procedures where high local use might represent an opportunity for disinvestment. However, there were barriers to achieving disinvestment in both procedure case studies. RCTs comparing CTR with conservative care indicated that surgery was clinically effective and cost-effective on average but provided limited evidence on patient subgroups to inform commissioning criteria and achieve savings. We found no RCTs of laser capsulotomy. The apparently high rate of capsulotomy was probably due to the coding inaccuracy; some savings might be achieved by greater use of outpatient procedures. Commissioning meetings were dominated by new funding requests. Benchmarking did not appear to be routinely carried out because of capacity issues and concerns about data reliability. Perceived barriers to disinvestment included lack of collaboration, central support and tools for disinvestment. Clinicians felt threshold criteria had little impact on their practice and that prior approval systems would not be cost-effective. Most patients were unaware of rationing.ConclusionsPolicy-makers could use geographical variation as a starting point to identify procedures where health technology reassessment or RCTs might be needed to inform policy. Commissioners can use benchmarking to identify procedures with high local use, possibly indicating overtreatment. However, coding inconsistency and limited evidence are major barriers to achieving disinvestment through benchmarking. Increased central support for commissioners to tackle disinvestment is needed, including tools, accurate data and relevant evidence. Early engagement with patients and clinicians is essential for successful local disinvestment.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Weitere HTA-basierte Initiativen zur Identifikation ineffektiver oder nicht angemessener medizinischer Leistungen [1] sind das "Framework for reviewing existing MBS (Medicare Benefits Schedule) items" (Australien) [33], die "Guideline for Not Funding existing Health Technologies in Health Care Systems" (GuNFT) (Spanien) [34,35] und das Schwedische Dis-InvestmentProjekt "Scientific Uncertainties" (Schweden) [36,37].…”

Section: Too Much Medicine Gb Und Internationalunclassified

Überversorgung: Initiativen zur Identifikation ineffektiver oder nicht bedarfsgerechter Leistungen

Wild

Mayer

2016

Wien Med Wochenschr

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A growing number of international initiatives rise to the challenge of reduction of medical overuse. Increasingly, these activities are promoted by physicians and clinicians, and aim to identify and avoid inappropriate health interventions. This article places the Choosing Wisely initiative within the context of less well-known activities, 13 all together, and briefly describes their characteristics; in addition, similarities and differences regarding their methods are elaborated.

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Guiding the process of health technology disinvestment

Cited by 38 publications

References 8 publications

A systematic review on current status of health technology reassessment: insights for South Korea

A systematic review on current status of health technology reassessment: insights for South Korea

Using clinical practice variations as a method for commissioners and clinicians to identify and prioritise opportunities for disinvestment in health care: a cross-sectional study, systematic reviews and qualitative study

Überversorgung: Initiativen zur Identifikation ineffektiver oder nicht bedarfsgerechter Leistungen

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