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DISINVESTING FROM INEFFECTIVE TECHNOLOGIES: LESSONS LEARNED FROM CURRENT PROGRAMS

Part of: Special Collection - Methods

Published online by Cambridge University Press:  23 December 2015

Julia Mayer  and
Anna Nachtnebel
Julia Mayer
Affiliation:
Ludwig Boltzmann Institute for Health Technology Assessment, Austria [email protected]
Anna Nachtnebel
Affiliation:
Ludwig Boltzmann Institute for Health Technology Assessment, Austria
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Abstract

Objectives: Many of the currently used health technologies have never been systematically assessed or are misused, overused or superseded. Therefore, they may be ineffective. Active identification of ineffectiveness in health care is gaining importance to facilitate best care for patients and optimal use of limited resources. The present research analyzed processes and experiences of programs for identifying ineffective health technologies. The goal of this study was to elucidate factors that facilitate implementation.

Methods: Based on an overview article, a systematic literature search and unsystematic hand-search were conducted. Further information was gained from international experts.

Results: Seven programs were identified that include identification, prioritization and assessment of ineffective health technologies and dissemination of recommendations. The programs are quite similar regarding their goals, target groups and criteria for identification and prioritization. Outputs, mainly HTA reports or lists, are mostly disseminated by means of the internet. Top–down and bottom–up programs both have benefits in terms of implementation of recommendations, either as binding guidelines and decisions or as nonbinding information for physicians and other stakeholders. Crucial facilitators of implementation are political will, transparent processes and broad stakeholder involvement focusing on physicians.

Conclusions: All programs can improve the quality of health care and enable cost reduction in supportive surrounding conditions. Physicians and patients must be continuously involved in the process of evaluating health technologies. Additionally, decision makers must support programs and translate recommendations into concrete actions.

Keywords

DisinvestmentObsolescenceHealth technology reassessmentResource allocationIneffective technologies
Type
Methods
Information
International Journal of Technology Assessment in Health Care , Volume 31 , Issue 6 , 2015 , pp. 355 - 362
Copyright
Copyright © Cambridge University Press 2015 

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References

REFERENCES

1. Haas, M, Hall, J, Viney, R, Gallego, G. Breaking up is hard to do: Why disinvestment in medical technology is harder than investment. Aust Health Rev. 2012;36:148–152.Google Scholar
2. Joshi, NP, Stahnish, FW, Noseworth, TW. Reassessment of health technologies: Obsolescence and waste. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH); 2009.Google Scholar
3. Center for Clinical Effectiveness. Health technology disinvestment: Tests, drugs and clinical practice. Report on a national disinvestment workshop. Melbourne, Australia: Center for Clinical Effectiveness; 2009.Google Scholar
4. Mc Kean, G, Noseworthy, T, Elshaug, A, Clement, F. Health technology reassessment: The art of the possible. Int J Technol Assess Health Care. 2013;29:418–423.Google Scholar
5. CHERE. Reducing the use of ineffective health care interventions. Centre for Health Economics Research and Evaluation, 2010. Working Paper 2010/5.Google Scholar
6. Leggett, L, Noseworthy, TW, Zarrabi, M, et al. Health technology reassessment of non-drug technologies: Current practices. Int J Technol Assess Health Care. 2012;28:220–227.Google Scholar
7. Gerdvilaite, J, Nachtnebel, A. Disinvestment. Overview of disinvestment experiences and challenges in selected countries. Vienna: Ludwig Boltzmann Institut for Health Technology Assessment (LBI HTA); 2011.Google Scholar
8. Garner, S, Littlejohns, P. Disinvestment from low value clinical interventions: NICEly done? BMJ. 2011;343:d4519.Google Scholar
9. Elshaug, AG, Hiller, JE, Tunis, SR, Moss, JR. Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Aust New Zealand Health Policy. 2007;4:23.CrossRefGoogle ScholarPubMed
10. Henshall, C, Schuller, T, Mardhani-Bayne, L. Using health technology assessment to support optimal use of technologies in current practice: The challenge of “disinvestment”. Int J Technol Assess Health Care. 2012;28:203–210.Google Scholar
11. Haines, T, O’Brien, L, McDermott, F, et al. A novel research design can aid disinvestment from existing health technologies with uncertain effectiveness, cost-effectiveness, and/or safety. J Clin Epidemiol. 2014;67:144–51.Google Scholar
12. Elshaug, AG, McWilliams, JM, Landon, BE. The value of low-value lists. JAMA. 2013;309:775–776.Google Scholar
13. Howard, DH, Shen, Y-C. Comparative effectiveness research, technological abandonment, and health care spending. Adv Health Econ Health Serv Res. 2012;23:103–121.Google Scholar
14. Scott, IA, Elshaug, AG. Foregoing low-value care: How much evidence is needed to change beliefs? Intern Med J. 2013;43:107–109.Google Scholar
15. Health Technology Assessment International [Internet]. HTAi subgroup on patient and citizen involvement. 2015. http://www.htai.org/interest-sub-groups/patient-and-citizen-involvement.html (accessed April 10, 2015).Google Scholar
16. Victorian Government Department of Human Services. Future directions for health technology uptake, diffussion and disinvestment in Victorian public health services. Workshop discussion paper. Melbourne, Australia: Victorian Government Department of Human Services; 2007.Google Scholar
17. Ibargoyen-Roteta, N, Gutierrez-Ibarluzea, I, Asua, J. Report on the development of the GuNFT guideline. Guideline for not funding existing health technologies in health care systems. Vitoria-Gasteiz: Basque Office for Health Technology Assessment Health Department Basque Government (OSTEBA); 2009.Google Scholar
18. Atienza Merino, G, Varela Lema, L. Needs and demands of policy-makers. In: Velasco, Garrido M, Børlum, Kristensen F, Palmhøj, Nielsen C, Busse, R, eds. Health technology assessment and health policy-making in Europe Current status, challenges and potential. Geneva: World Health Organization; 2008.Google Scholar
19. Mitton, C. Questionnaire: Identifying models and strategies for optimal resource allocation and disinvestment in health care systems- Focus on PBMA. 2013.Google Scholar
20. 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
21. Chamberlain, CA, Martin, RM, Busby, J, et al. Trends in procedures for infertility and caesarean sections: Was NICE disinvestment guidance implemented? NICE recommendation reminders. BMC Public Health. 2013;13:112.CrossRefGoogle ScholarPubMed
22. Lavis, JN, Røttingen, J-A, Bosch-Capblanch, X, et al. Guidance for evidence-informed policies about health systems: Linking guidance development to policy development. PLoS Med. 2012;9:e1001186.Google Scholar