Abstract:Many challenges need to be overcome for a disinvestment initiative to be successful, and sharing particular experiences with the international community would increase the chances of positive outcomes. The present study highlights the need for publication of such experiences in LAC.
“…As healthcare decision makers continue to face challenges in health services delivery to their patient population with increasing costs and limited resources, disinvestment programs and initiatives are being established internationally as one approach to maintain a sustainable healthcare system (1)(2)(3)(4). Numerous disinvestment programs were established after 2006 (4).…”
ObjectivesAs healthcare decision makers continue to face challenges in health services delivery to their patients, disinvestment programs are being established for a sustainable healthcare system. This study aimed to collect data and information by means of a survey of disinvestment candidates and ongoing disinvestment projects in the health technology assessment (HTA) community.MethodsAn online survey was conducted to collect information on disinvestment candidates and activities from members of the Health Technology Assessment International Disinvestment & Early Awareness Interest Group, the EuroScan International Network and International Network of Agencies for Health Technology Assessment.ResultsAmong the 362 invitees, twenty-four unique responses were received, and almost 70 percent were involved in disinvestment initiatives. The disinvestment candidates identified represented a range of health technologies. Evidence or signaling of clinical ineffectiveness or inappropriate use typically led to the nomination of disinvestment candidates. Health technology assessments and reassessments were usually conducted to evaluate the technology in question, and decisions usually led to the limited use of the technology. Barriers to disinvestment decisions included the strength of interest and advocacy groups, insufficient data for assessments, a systematic decision process and political challenges, while obstacles to their implementation were clinicians’ reluctance and insufficient funding and incentives.ConclusionsThe survey results suggested that disinvestment activities are occurring in the HTA community, especially in the public sector. Future research can further investigate the processes and methods used to reach and implement disinvestment decisions from our survey respondents and explore to form closer ties between the HTA and clinical communities.
“…As healthcare decision makers continue to face challenges in health services delivery to their patient population with increasing costs and limited resources, disinvestment programs and initiatives are being established internationally as one approach to maintain a sustainable healthcare system (1)(2)(3)(4). Numerous disinvestment programs were established after 2006 (4).…”
ObjectivesAs healthcare decision makers continue to face challenges in health services delivery to their patients, disinvestment programs are being established for a sustainable healthcare system. This study aimed to collect data and information by means of a survey of disinvestment candidates and ongoing disinvestment projects in the health technology assessment (HTA) community.MethodsAn online survey was conducted to collect information on disinvestment candidates and activities from members of the Health Technology Assessment International Disinvestment & Early Awareness Interest Group, the EuroScan International Network and International Network of Agencies for Health Technology Assessment.ResultsAmong the 362 invitees, twenty-four unique responses were received, and almost 70 percent were involved in disinvestment initiatives. The disinvestment candidates identified represented a range of health technologies. Evidence or signaling of clinical ineffectiveness or inappropriate use typically led to the nomination of disinvestment candidates. Health technology assessments and reassessments were usually conducted to evaluate the technology in question, and decisions usually led to the limited use of the technology. Barriers to disinvestment decisions included the strength of interest and advocacy groups, insufficient data for assessments, a systematic decision process and political challenges, while obstacles to their implementation were clinicians’ reluctance and insufficient funding and incentives.ConclusionsThe survey results suggested that disinvestment activities are occurring in the HTA community, especially in the public sector. Future research can further investigate the processes and methods used to reach and implement disinvestment decisions from our survey respondents and explore to form closer ties between the HTA and clinical communities.
“…Eight reviews described international disinvestment initiatives with descriptions on countries that already implemented disinvestment programs (3;7;11–16). Two of the included studies discussed regional disinvestment initiatives, in European HTA agencies (17) and in Latin American countries (18). Figure 1.PRISMA flow diagram of the scoping review (10).…”
Section: Resultsmentioning
confidence: 99%
“…The outcomes of disinvestment decisions were mixed. Some reviews highlighted the requirement of making decisions (i.e., binding judgments) (13;14;20), while some outlined the resulting outcomes that may occur following the assessment (i.e., nonbinding information) (3;11;15;18;22;24). According to Mayer and Nachtnebel (14), the implementation of disinvestment decisions may result in one of these four conditions: (i) a change in application or scope of use; (ii) full or partial resource withdrawal; (iii) complete removal from practice, or (iv) no change to the practice.…”
Section: Resultsmentioning
confidence: 99%
“…This, combined with an evidence-based strategy and transparent process, further enhanced the acceptance (7;11;13;14;21;22;25). Thirdly, the consideration on local context when evaluating the candidates for disinvestment and in formulating recommendations facilitates implementation (7;14;18;21). Various dissemination strategies were also customized to relevant target groups, making the information more acceptable and comprehensible (11;12;14;20).…”
Objectives
Disinvestment from low value health technologies is growing globally. Diverse evidence gathering and assessment methods were used to implement disinvestment initiatives, however, less than half of the empirical studies report reduced use of the low-value services. This scoping review aimed to synthesize the information from available reviews on the concepts and purposes of disinvestment in healthcare, the approaches and methods used, the role of stakeholders and facilitators and barriers in its implementation.
Methods
This scoping review was guided by the Joanna Briggs Institute Manual for Evidence Synthesis and PRISMA statement for scoping review. Published reviews on disinvestment were identified from scientific databases including health technology assessment (HTA) Web sites using the terms “disinvestment,” “health technology reassessment,” and “healthcare.” The data obtained was synthesized narratively to identify similarities and differences across the approaches based on the prespecified categories.
Results
Seventeen reviews were included with thirty-four initiatives identified across sixteen countries at various levels of implementation and responsible agencies for the activities. Two most used methods to facilitate disinvestment decisions are Programme Budgeting and Marginal Analysis (PBMA) and HTA. Stakeholder involvement is the most important aspect to be addressed, as it acts as both facilitator and barrier in disinvestment initiatives implementation.
Conclusions
Disinvestment programs have been implemented at multilevel, involving multistakeholders and using multiple methods such as PBMA and HTA. However, there is a lack of clarity on the additional dimensions of technical analysis related to these tools. Further research could focus on technology optimization in healthcare as part of overall health technology management.
“…In Latin America, Agirrezabal et al named some local disinvestment initiatives, although most of them did not present a comprehensive description of the process used in finding, prioritizing, evaluating, implementing, and the results of the disinvestment. Four studies referred to Brazilian cases, and only one was considered as a potential disinvestment approach [26]. In this case, Conitec assessed the intramuscular interferon beta-1a performance for multiple sclerosis.…”
Background
The reassessment of technologies and services offered by healthcare systems is recent initiative and still without a widely adopted and evaluated method. To a better understanding of this process in Brazil, we have described the health technology reassessment (HTR) performed by the National Committee for Health Technology Incorporation (Conitec) into Brazilian public health system (SUS).
Methods
A documental, exploratory, descriptive, retrospective study with qualitative-quantitative approach regarding the HTR performed by Conitec from January 2012 to November 2017.
Results
After applying the criteria of inclusion and exclusion, we selected 47 technologies for this study. The vast majority of the demands (41 demands) came from the public sector, and only six from the private sector. Most of the requests referred to the exclusion of specific indication; followed by extension of use, withdraw of the technology from SUS, maintenance, and restriction of use. The dimensions of analysis found in the recommendation reports were scientific evidence on efficacy, effectiveness and safety, disease-related issues, issues related to the use of technology, costs, and social participation. However, these dimensions were not included in all analysis, and a standardized structure of the reports has not been observed. The most relevant decision factors considered for decision-making were efficacy, safety and use of the technology.
Conclusion
During a six-year period of Conitec actuation, we could find some reassessments of technologies that are available in SUS. We observed that these activities had enabled progress, however, they are still not yet structured, with gaps in the selection process, and the assessment since no methodology and criteria for proper conduct were established.
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