Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-17T17:04:41.419Z Has data issue: false hasContentIssue false
  • English
  • Français

STATUS OF DISINVESTMENT INITIATIVES IN LATIN AMERICA: RESULTS FROM A SYSTEMATIC LITERATURE REVIEW AND A QUESTIONNAIRE

Published online by Cambridge University Press:  28 September 2017

Ion Agirrezabal ,
Joseph Burgon ,
Gavin Stewart  and
Iñaki Gutierrez-Ibarluzea
Ion Agirrezabal
Affiliation:
Costello Medical [email protected]
Joseph Burgon
Affiliation:
Costello Medical Consulting
Gavin Stewart
Affiliation:
Costello Medical Consulting
Iñaki Gutierrez-Ibarluzea
Affiliation:
Basque Office for HTA (OSTEBA)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Disinvestment of existing healthcare technologies that deliver low or no health benefit for their cost can be used as a tool to improve access to effective technologies, while ensuring the long-term sustainability of healthcare systems. The objective of this research was to identify disinvestment initiatives in Latin American countries (LAC).

Methods: First, a systematic literature review (SLR) was conducted. In February 2015, MEDLINE, MEDLINE In-Process, EMBASE, The Cochrane Library, and LILACS were searched for relevant journal articles, including terms related to “disinvestment,” “reallocation,” “obsolete technologies,” and “Latin America.” Additionally, a manual search of documents from Latin American health technology assessment agencies was performed. Second, an online questionnaire was sent to experts in LAC to assess whether unpublished real-life disinvestment initiatives exist. Questionnaire results were collected in September 2015.

Results: From the SLR, 350 records were selected for screening following de-duplication and eleven articles fulfilled inclusion criteria. Only two of these reported information on initiatives potentially identifiable as disinvestment-investment activities in Brazil and Peru. Nine respondents completed the questionnaire, and four reported that disinvestment initiatives had been conducted in their respective organizations in Argentina, Brazil, and Mexico. This lack of agreement between the SLR and the questionnaire responses shows that disinvestment initiatives are ongoing, despite being under reported.

Conclusions: 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.

Keywords

DisinvestmentHealth technology assessmentReassessmentReviewLatin America
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 33 , Issue 6 , 2017 , pp. 674 - 680
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Elshaug, AG, Hiller, JE, Moss, JR. Exploring policy-makers' perspectives on disinvestment from ineffective healthcare practices. Int J Technol Assess Health Care. 2008;24:1–9.CrossRefGoogle ScholarPubMed
2. Garcia-Armesto, S, Campillo-Artero, C, Bernal-Delgado, E. Disinvestment in the age of cost-cutting sound and fury. Tools for the Spanish National Health System. Health Policy. 2013;110:180–185.CrossRefGoogle ScholarPubMed
3. Ibargoyen-Roteta, N, Gutierrez-Ibarluzea, I, Asua, J. Guiding the process of health technology disinvestment. Health Policy. 2010;98: 218–226.Google Scholar
4. Ferri, CP. Population ageing in Latin America: Dementia and related disorders. Rev Bras Psiquiatr. 2012;34:371–374.Google Scholar
5. Goss, PE, Lee, BL, Badovinac-Crnjevic, T, et al. Planning cancer control in Latin America and the Caribbean. Lancet Oncol. 2013;14:391–436.CrossRefGoogle ScholarPubMed
6. Rodriguez-Iturbe, B. Progress in the prevention of chronic kidney disease in Latin America. Nat Clin Pract Nephrol. 2008;4:233.CrossRefGoogle ScholarPubMed
7. The Lancet Diabetes Endocrinology. Obesity prevention in Latin America: Now is the time. Lancet Diabetes Endocrinol. 2014;2:263.Google Scholar
8. Polisena, J, Clifford, T, Elshaug, AG, et al. Case studies that illustrate disinvestment and resource allocation decision-making processes in health care: A systematic review. Int J Technol Assess Health Care. 2013;29:174–184.Google Scholar
9. Mitton, C, Dionne, F, Damji, R, Campbell, D, Bryan, S. Difficult decisions in times of constraint: Criteria based resource allocation in the Vancouver Coastal Health Authority. BMC Health Serv Res. 2011;11:169.Google Scholar
10. Blaya, JA, Gomez, W, Rodriguez, P, Fraser, H. Cost and implementation analysis of a personal digital assistant system for laboratory data collection. Int J Tuberc Lung Dis. 2008;12:921–927.Google Scholar
11. Kilsztajn, S, Lopes Ede, S, Lima, LZ, Rocha, PA, Carmo, MS. [Hospital beds and mental health reform in Brazil]. Cad Saude Publica. 2008;24:2354–2362.Google Scholar
12. Caires de Souza, AL, de Assis Acurcio, F, Guerra Junior, AA, et al. Insulin glargine in a Brazilian state: Should the government disinvest? An assessment based on a systematic review. Appl Health Econ Health Policy. 2014;12:19–32.CrossRefGoogle Scholar
13. Capucho, H, Mastroianni, P, Cuffini, S. Farmacovigilância no Brasil: A relação entre polimorfi smo de fármacos, efetividade e segurança dos medicamentos. Rev Ciênc Farm Básica Apl. 2008;29:277–283.Google Scholar
14. Colomar, M, Belizan, M, Cafferata, ML, et al. [Practices of maternal and perinatal care performed in public hospitals of Uruguay]. Ginecol Obstet Mex. 2004;72:455–465.Google Scholar
15. Conde-Agudelo, A, Rosas-Bermudez, A, Gulmezoglu, AM. Evidence-based intrapartum care in Cali, Colombia: A quantitative and qualitative study. BJOG. 2008;115:1547–1556.Google Scholar
16. de Souza, AL, Acurcio Fde, A, Guerra Junior, AA, et al. Authors' reply to Dr. Malerbi: “Insulin glargine in a Brazilian state: Should the government disinvest?”. Appl Health Econ Health Policy. 2014;12: 561–563.Google Scholar
17. Malerbi, DA. Comment on: “Insulin glargine in a Brazilian state: Should the government disinvest?”. Appl Health Econ Health Policy. 2014;12:559–560.Google Scholar
18. Calderon, RB, Depine, S. Sustainable and tenable renal health model: A Latin American proposal of classification, programming, and evaluation. Kidney Int Suppl. 2005:S23–S30.Google Scholar
19. Nobre, FF, Trotta, LT, Gomes, LF. Multi-criteria decision making–an approach to setting priorities in health care. Stat Med. 1999;18:3345–3354.Google Scholar
20. Vargas-Lagos, V. How should resources be reallocated between physicians and nurses in Africa and Latin America? Soc Sci Med. 1991;33:723–727.Google Scholar
21. Rubinstein, A, Pichon-Riviere, A, Augustovski, F. Development and implementation of health technology assessment in Argentina: Two steps forward and one step back. Int J Technol Assess Health Care. 2009;25 (Suppl 1):260–269.Google Scholar
22. Lovato-Pires de Lemos, L, Alvares, J, Resende-Faleiros, D, et al. Methodological guideline for disinvestment in Brazil. CCATES. 2015. http://www.ccates.org.br/content/_pdf/en_PUB_1437692942.pdf (accessed October 20, 2016).Google Scholar
23. Elshaug, AG, Watt, AM, Moss, JR, Hiller, JE. Policy perspectives on the obsolescence of health technologies in Canada. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2009.Google Scholar
24. International Monetary Fund. Growth in Latin America weakens for fifth year in a row. 2015. http://www.imf.org/external/pubs/ft/survey/so/2015/CAR042915A.htm (accessed August 15, 2015).Google Scholar
25. World Bank. Latin America and Caribbean overview. 2015. http://www.worldbank.org/en/region/lac/overview (accessed August 15, 2016).Google Scholar
Supplementary material: File

Agirrezabal et al supplementary mateirial 1

Supplementary Table

Download Agirrezabal et al supplementary mateirial 1(File)
File 16.7 KB