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Session: Disinvestment policy and practice
Room: Helsinki Hall
Time: Fri 11:45-13:00

Presenter: Gisselle Gallego (University of Technology, Sydney. Centre for Health Economics Research and Evaluation (CHERE))

Abstract

Aim: The objective of this study was to conduct a review of the international and national literature (including grey literature) to identify current practices and describe different approaches for identifying existing health care interventions that are ineffective, and for reducing the use of these interventions.

Methods: The literature was searched to identify studies and reports published between January 1990 and Aug 2009. Databases of peer-reviewed literature including CINAHL, EMBASE, Medline, and PubMed were searched. The bibliographies of all retrieved publications were hand searched for any relevant references missing in the database searches. The Centre for Reviews & Dissemination database and the EBM Reviews - Health Technology Assessment were also searched. Health technology assessment (HTA) organisation websites were also consulted. Web-based searches, using the internet search engines ‘Google’ and ‘Google scholar’, were conducted to identify national and international reports. Grey literature such as conference abstracts and reports were also included.

Results: The search identified 36 original papers. Of these only seven were relevant to the review. These were mainly viewpoints and commentaries on disinvestment. Most of the data comes from the grey literature, that is, mainly conference abstracts and presentations. In this situation, the information is limited to what is provided at the meeting (i.e. on the presentation slides). The majority of the presentations are dated 2004-onwards with increasing numbers of abstracts identified in the last two years. The literature review identified numerous case studies, and a range of less formal mechanisms, but few health authorities have developed active processes, particularly for disinvestment in activities which are considered not to be effective or cost-effective. The number of case studies identified in this literature review is also an indication that even though structures, processes and mechanisms relating to disinvestment might be in place, limited information is actually published.

Conclusions: Overall, this literature review has demonstrated that there are very limited formal mechanisms for undertaking explicit disinvestment activities, either in terms of the formal technology appraisal processes or the implementation of disinvestment. There are numerous case studies, and a range of less formal mechanisms, but few health authorities have developed active processes, particularly for disinvestment in activities which are considered not to be cost-effective. Disinvestment tends to focus on ineffective and/or unsafe technologies, and most often, the mechanisms for disinvestment are implicit or passive. The limited nature of disinvestment also limits the extent to which there has been any evaluation of disinvestment practices.

Key Terms

disinvestment, HTA, cost effectiveness

Authors:

Gisselle Gallego (University of Technology, Sydney. Centre for Health Economics Research and Evaluation (CHERE)) , Marion Haas (University of Technology, Sydney. Centre for Health Economics Research and Evaluation (CHERE)) , Jane Hall (University of Technology, Sydney. Centre for Health Economics Research and Evaluation (CHERE)) and Rosalie Viney (University of Technology, Sydney. Centre for Health Economics Research and Evaluation (CHERE))

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