Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-05T15:31:50.423Z Has data issue: false hasContentIssue false

Disinvestment in healthcare: a scoping review of systematic reviews

Published online by Cambridge University Press:  20 July 2022

Hanin Farhana Kamaruzaman*
Affiliation:
Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
Eleanor Grieve
Affiliation:
Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
Olivia Wu
Affiliation:
Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
*
*Author for correspondence: Hanin Farhana Kamaruzaman, E-mail: [email protected]

Abstract

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.

Type
Assessment
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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.)

Footnotes

We would like to thank the members of Health Economics and Health Technology Assessment (HEHTA), University of Glasgow, for their helpful discussions on this work.

References

Elshaug, AG, Hiller, JE, Moss, JR (2008 ) Exploring policy-makers’ perspectives on disinvestment from ineffective healthcare practices. Int J Technol Assess Health Care. 24, 19.CrossRefGoogle ScholarPubMed
Ibargoyen-Roteta, N, Gutierrez-Ibarluzea, I, Asua, J (2010) Guiding the process of health technology disinvestment. Health Policy. 98, 218226.CrossRefGoogle ScholarPubMed
Chambers, JD, Salem, MN, D’Cruz, BN, et al (2017) A review of empirical analyses of disinvestment initiatives. Value Health. 20, 909918.CrossRefGoogle ScholarPubMed
World Health Organization (2021) Global expenditure on health: Public spending on the rise? Geneva: World Health Organization; [cited on 22 Apr 2022]. Available at: https://apps.who.int/iris/bitstream/handle/10665/350560/9789240041219-eng.pdf.Google Scholar
Peters, MD, Godfrey, C, McInerney, P, et al (2020) Chapter 11: Scoping reviews (2020 version). In: Aromataris, E, Munn, Z, eds. JBI Manual for evidence synthesis, JBI; Adelaide: Joanna Briggs Institute; [cited on 21 Aug 2021]. Available at: https://synthesismanual.jbi.global.Google Scholar
Tricco, AC, Lillie, E, Zarin, W, et al (2018) PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 169, 467473.CrossRefGoogle ScholarPubMed
Niven, DJ, Mrklas, KJ, Holodinsky, JK, et al (2015) Towards understanding the de-adoption of low-value clinical practices: A scoping review. BMC Med. 13, 255.CrossRefGoogle ScholarPubMed
Okoli, C (2015) A guide to conducting a standalone systematic literature review. Commun Assoc Inf Syst. 37, 43.Google Scholar
Khalil, H, McInerney, P, Pollock, D, et al (2021) Practical guide to undertaking scoping reviews for pharmacy clinicians, researchers and policymakers. J Clin Pharm Ther. 47, 129134.CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, Group, TP (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 6, e100097.CrossRefGoogle ScholarPubMed
Maloney, MA, Schwartz, L, O’Reilly, D, Levine, M (2017) Drug disinvestment frameworks: Components, challenges, and solutions. Int J Technol Assess Health Care. 33, 261269.CrossRefGoogle ScholarPubMed
Orso, M, de Waure, C, Abraha, I, et al (2017) Health technology disinvestment worldwide: Overview of programs and possible determinants. Int J Technol Assess Health Care. 33, 239250.CrossRefGoogle ScholarPubMed
Seo, HJ, Park, JJ, Lee, SH (2016) A systematic review on current status of health technology reassessment: Insights for South Korea. Health Res Policy Syst. 14, 110.CrossRefGoogle ScholarPubMed
Mayer, J, Nachtnebel, A (2015) Disinvesting from ineffective technologies: Lessons learned from current programs. Int J Technol Assess Health Care. 31, 355362.CrossRefGoogle ScholarPubMed
Polisena, J, Clifford, T, Elshaug, AG, (2013 ) Case studies that illustrate disinvestment and resource allocation decision-making processes in health care: A systematic review. Int J Technol Assess Health Care. 29, 174184.CrossRefGoogle ScholarPubMed
Leggett, L, Noseworthy, TW, Zarrabi, M, et al (2012) Health technology reassessment of non-drug technologies: Current practices. Int J Technol Assess Health Care. 28, 220227.CrossRefGoogle ScholarPubMed
Calabro, GE, La Torre, G, de Waure, C, et al (2018) Disinvestment in healthcare: An overview of HTA agencies and organizations activities at European level. BMC Health Serv Res. 18, 17.CrossRefGoogle ScholarPubMed
Agirrezabal, I, Burgon, J, Stewart, G, Gutierrez-Ibarluzea, I (2017) Status of disinvestment initiatives in Latin America: Results from a systematic literature review and a questionnaire. Int J Technol Assess Health Care. 33, 674680.CrossRefGoogle ScholarPubMed
Walsh-Bailey, C, Tsai, E, Tabak, RG, et al (2021) A scoping review of de-implementation frameworks and models. Implement Sci. 16, 118.CrossRefGoogle ScholarPubMed
Embrett, M, Randall, GE, Lavis, JN, Dion, ML (2020) Conceptualising characteristics of resources withdrawal from medical services: A systematic qualitative synthesis. Health Res Policy Syst. 18, 113.CrossRefGoogle ScholarPubMed
Esandi, ME, Gutiérrez-Ibarluzea, I, Ibargoyen-Roteta, N, Godman, B (2020) An evidence-based framework for identifying technologies of no or low-added value (NLVT). Int J Technol Assess Health Care. 36, 5057.CrossRefGoogle Scholar
Soril, LJ, Niven, DJ, Esmail, R, Noseworthy, TW, Clement, FM (2018) Untangling, unbundling, and moving forward: Framing health technology reassessment in the changing conceptual landscape. Int J Technol Assess Health Care. 34, 212217.CrossRefGoogle ScholarPubMed
Garner, S, Docherty, M, Somner, J, et al (2013 ) Reducing ineffective practice: Challenges in identifying low-value health care using Cochrane systematic reviews. J Health Serv Res Policy. 18, 612.CrossRefGoogle ScholarPubMed
Parkinson, B, Sermet, C, Clement, F, et al (2015) Disinvestment and value-based purchasing strategies for pharmaceuticals: An international review. Pharmacoecon. 33, 905924.CrossRefGoogle Scholar
Mitchell, D, Bowles, K-A, O’Brien, L, Bardoel, A, Haines, T (2021) Health care staff responses to disinvestment—A systematic search and qualitative thematic synthesis. Health Care Manage Rev. 46, 4454.CrossRefGoogle ScholarPubMed
Rooshenas, L, Owen-Smith, A, Hollingworth, W, et al (2015) “I won’t call it rationing…”: An ethnographic study of healthcare disinvestment in theory and practice. Soc Sci Med. 128, 273281.CrossRefGoogle Scholar
Elshaug, AG, Hiller, JE, Tunis, SR, Moss, JR (2007) Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Aust New Zealand Health Policy. 4, 23.CrossRefGoogle ScholarPubMed
Garner, S, Littlejohns, P (2011) Disinvestment from low value clinical interventions: NICEly done? BMJ. 343, d4519.CrossRefGoogle Scholar
The Canadian Agency for Drugs and Technologies in Health (CADTH) (2019) Health technology reassessement: An Overview of Canadian and international processes. Environmental scan no.85 [Internet]; [cited on 23 Jul 2021]. Available at: https://www.cadth.ca/health-technology-reassessment-overview-canadian-and-international-processes.Google Scholar
The National Institute for Health and Care Excellence (NICE) Cost saving and resource planning guidance [Internet]; [cited on 16 Aug 2021]. Available at: https://www.nice.org.uk/about/what-we-do/our-programmes/cost-savings-resource-planning.Google Scholar
Mortimer, D (2010) Reorienting programme budgeting and marginal analysis (PBMA) towards disinvestment. BMC Health Serv Res. 10, 110.CrossRefGoogle ScholarPubMed
Mitton, C, Seixas, BV, Peacock, S, Burgess, M, Bryan, S (2019) Health technology assessment as part of a broader process for priority setting and resource allocation. Appl Health Econs Health Policy. 17, 573576.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Kamaruzaman et al. supplementary material

Kamaruzaman et al. supplementary material

Download Kamaruzaman et al. supplementary material(PDF)
PDF 189.9 KB