Skip to main content Accessibility help
×
Home

DRUG DISINVESTMENT FRAMEWORKS: COMPONENTS, CHALLENGES, AND SOLUTIONS

  • Mary Alison Maloney (a1), Lisa Schwartz (a2), Daria O'Reilly (a3) and Mitchel Levine (a3)

Abstract

Objectives: Value assessments of marketed drug technologies have been developed through disinvestment frameworks. Components of these frameworks are varied and implementation challenges are prevalent. The objective of this systematic literature review was to describe disinvestment framework process components for drugs and to report on framework components, challenges, and solutions.

Methods: A systematic literature search was conducted using the terms: reassessment, reallocation, reinvestment, disinvestment, delist, decommission or obsolescence in MEDLINE, EMBASE, NLM PubMed, the Cochrane Library, and CINAHL from January 1, 2000, until November 14, 2015. Additional citations were identified through a gray literature search of Health Technology Assessment international (HTAi) and the International Network of Agencies for Health Technology Assessment (INAHTA) member Web sites and from bibliographies of full-text reviewed manuscripts.

Results: Sixty-three articles underwent full text review and forty were included in the qualitative analysis. Framework components including disinvestment terms and definitions, identification and prioritization criteria and methods, assessment processes, stakeholders and dissemination strategies, challenges, and solutions were compiled. This review finds that stakeholders lack the political, administrative, and clinical will to support disinvestment and that there is not one disinvestment framework that is considered best practice.

Conclusions: Drug technology disinvestment components and processes vary and challenges are numerous. Future research should focus on lessening value assessment challenges. This could include adopting more neutral framework terminology, setting fixed reassessment timelines, conducting therapeutic reviews, and modifying current qualitative decision-making assessment frameworks.

Copyright

References

Hide All
1. Garner, S, Littlejohns, P. Disinvestment from low value clinical interventions: NICEly done? BMJ. 2011;343:d4519.
2. MacKean, G, Noseworthy, T, Elshaug, AG, et al. Health technology reassessment: The art of the possible. Int J Technol Assess Health Care. 2013;29:418-423.
3. Moher, D, Liberati, A, Tetzlaff, J, Group, Altman DG; PRISMA. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med. 2009;151:264-269. W64.
4. Elshaug, AG, Hiller, J, Tunis, SR, Moss, J. Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Aust New Zealand Health Policy. 2007;4:23.
5. Gnjidic, D, Elshaug, AG. De-adoption and its 43 related terms: Harmonizing low-value care terminology. BMC Med. 2015;13:273.
6. Ibargoyen-Roteta, N, Gutierrez-Ibarluzea, I, Asua, J. Guiding the process of health technology disinvestment. Health Policy. 2010;98:218-226.
7. Parkinson, B, Sermet, C, Clement, F, et al. Disinvestment and value-based purchasing strategies for pharmaceuticals: An international review. Pharmacoeconomics. 2015;33:905-924.
8. Wilson, MG, Ellen, ME, Lavis, JN, et al. Processes, contexts, and rationale for disinvestment: A protocol for a critical interpretive synthesis. Syst Rev. 2014;3:143.
9. Elshaug, AG, Moss, J, Littlejohns, P, Karnon, J, Merlin, T, Hiller, J. Identifying existing health care services that do not provide value for money. Med J Aust. 2009;190:269-373.
10. Gerdvilaite, J, Nachtnebel, A. Disinvestment: Overview of disinvestment experiences and challenges in selected countries. 2011. http://eprints.hta.lbg.ac.at/926/# (accessed January 30, 2016).
11. Healthcare Improvement Scotland. Technologies scoping report. 2013. http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/earlier_scoping_reports/technologies_scoping_report_16.aspx (accessed January 31, 2016).
12. Alberta Health Services. Reassessment Program. 2016. http://www.albertahealthservices.ca/info/Page4144.aspx (accessed January 30, 2016).
13. Health Policy Advisory Committee on Technology. Disinvestment in Australia and New Zealand. Australia: Queensland Health; 2013.
14. Elshaug, AG, Hiller, J, Moss, J. Exploring policy-makers' perspectives on disinvestment from ineffective healthcare practices. Int J Technol Assess Health Care. 2008;24:1-9.
15. Morland, B. Methods of no value must be abandoned. Tidsskr Nor Laegeforen. 2010;130:1256-1257.
16. Ruano Ravina, A, Velasco Gonzalez, M, Varela Lema, L, et al. Identification, prioritisation and assessment of obsolete health technologies. A methodological guideline. Santiago de ComPostela: Galician Agency for Health Technology Assessment (AVALIA-T); 2007.
17. Joshi, N, Stahlnisch, F, Noseworthy, T. Reassessment of heath technologies: Obsolescence and waste. 2009. http://www.cadth.ca/reassessment-health-technologies-obsolescence-and-waste (accessed February 6, 2016).
18. Albert Health Services. Health Technology Assessment & Innovation Department Annual Report (April 1, 2010 - March 31, 2011). 2011. http://www.albertahealthservices.ca/assets/Infofor/Researchers/if-res-htai-annual-report.pdf (accessed January 30, 2016).
19. Garner, S, Docherty, M, Somner, J, et al. Reducing ineffective practice: Challenges in identifying low-value health care using Cochrane systematic reviews. J Health Serv Res Policy. 2013;18:6-12.
20. Hughes, D, Ferner, R. New drugs for old: Disinvestment and NICE. BMJ. 2010;340:c572.
21. 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.
22. Health Quality Ontario. Appropriateness initiative. 2014. http://www.hqontario.ca/Evidence/Evidence-Process/Appropriateness-Initiative (accessed January 30, 2016).
23. 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.
24. Pearson, S, Littlejohns, P. Reallocating resources: How should the National Institute for Health and Clinical Excellence guide disinvestment efforts in the national health service? J Health Serv Res Policy. 2007;12:160-165.
25. Scottish Health Technologies Group. Scottish health technologies group development day 2013. 2013. http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg/about_the_group/shtg_development_day_2013.aspx (accessed January 31, 2016).
26. 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.
27. Paprica, A, Culyer, A, Elshaug, A, Peffer, J, Sandoval, G. From talk to action: Policy stakeholders, appropriateness, and selective disinvestment. Int J Technol Assess Health Care. 2015;31:236-240.
28. Ibargoyen-Roteta, N, Gutierrez-Ibarluzea, I, Asua, J, Benguria-Arrate, G, Galnares-Cordero, L. Scanning the horizon of obsolete technologies: Possible sources for their identification. Int J Technol Assess Health Care. 2009;25:249-254.
29. Polisena, J, Clifford, T, Elshaug, AG, Mitton, C, Russell, E, Skidmore, B. 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.
30. Goodman, C. HTA 101: Introduction to Health Technology Assessment. http://www.nlm.nih.gov/nichsr/hta101.pdf (accessed December 19, 2015).
31. Noseworthy, T, Clement, F. Health technology reassessment: Scope, methodology, & language. Int J Technol Assess Health Care. 2012;28:201-202.
32. Elshaug, A, Watt, A, Moss, J, Hiller, J. Policy perspectives on the obsolescence of health technologies in Canada. 2009. http://www.cadth.ca/collaboration-and-outreach/advisory-bodies/policy-forum/discussion-papers/policy-perspectives-obsolescence-health (accessed February 6, 2016).
33. European Medicines Agency. Benefit-risk methodology project. Work package 4 report: Benefit-risk tools and processes. 2012. http://www.ema.europa.eu/docs/en_GB/document_library/Report/2012/03/WC500123819.pdf (accessed October 12, 2016).
34. US Food and Drug Administration. PDUFA re-authorisation performance goals and procedures fiscal years 2013 through 2017. 2012. http://www.fda.gov/downloads/ForIndustry/UserFees/PrescriptionDrugUserFee/UCM270412.pdf (accessed October 14, 2016).
35. 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;67:144-151.1
36. Moynihan, RN. A healthy dose of disinvestment. Med J Aust. 2012;196:158.
37. Watt, AM, Hiller, JE, Braunack-Mayer, AJ, et al. The ASTUTE health study protocol: Deliberative stakeholder engagements to inform implementation approaches to healthcare disinvestment. Implement Sci. 2012;7:101.
38. 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. 2007. http://www9.euskadi.net/sanidad/osteba/datos/e_10_11_report_GuNFT.pdf (accessed January 31, 2016).
39. Fenwick, E, Claxton, K, Sculpher, M, Briggs, A. Improving the efficiency and relevance of health technology assessment: The role of iterative decision analytic modelling. 2000. https://www.york.ac.uk/che/pdf/DP179.pdf (accessed January 31, 2016).
40. Hollingworth, W, Chamberlain, C. NICE recommendations for disinvestment. BMJ. 2011;343:d5772.
41. Jaurlaritza, IE. HTAI summit examines disinvestment and the most cost-effective ways to manage current health technology. 2012. http://www.irekia.euskadi.eus/en/news/11317-htai-summit-examines-disinvestment-and-the-most-cost-effective-ways-manage-current-health-technology (accessed January 16, 2016).
42. Scottish Health Technologies Group. Making choices spending wisely (MaCSWise) A report of current practice in NHSScotland relating to National Institute of Health and Clinical Excellence cost-saving recommendations. 2012. http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_ad_hoc/macswise_report.aspx (accessed February 6, 2016).
43. Watt, AM, Willis, CD, Hodgetts, K, Elshaug, AG, Hiller, JE. Engaging clinicians in evidence-based disinvestment: Role and perceptions of evidence. Int J Technol Assess Health Care. 2012;28:211-219.
44. Mayer, J, Nachtnebel, A. Identification of ineffective interventions and technologies: Existing models and their implementation. 2013. http://eprints.hta.lbg.ac.at/1014/ (accessed February 7, 2016).
45. O'Callaghan, G, Meyer, H, Elshaug, AG. Choosing wisely: The message, messenger and method. Med J Aust. 2015;202:175-177.

Keywords

Type Description Title
WORD
Supplementary materials

Maloney supplementary material
Maloney supplementary material 1

 Word (80 KB)
80 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed