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HEALTH TECHNOLOGY DISINVESTMENT WORLDWIDE: OVERVIEW OF PROGRAMS AND POSSIBLE DETERMINANTS

Published online by Cambridge University Press:  03 July 2017

Massimiliano Orso ,
Chiara de Waure ,
Iosief Abraha ,
Carlo Nicastro ,
Francesco Cozzolino ,
Paolo Eusebi  and
Alessandro Montedori
Massimiliano Orso
Affiliation:
Health Planning Service, Regional Health Authority of Umbria, Department of Epidemiologymassi.orso@hotmail.it
Chiara de Waure
Affiliation:
Catholic University of the Sacred Heart, Institute of Public Health
Iosief Abraha
Affiliation:
Health Planning Service, Regional Health Authority of Umbria, Department of Epidemiology
Carlo Nicastro
Affiliation:
Perugia Hospital Trust, Directorate Purchasing and Procurement
Francesco Cozzolino
Affiliation:
Health Planning Service, Regional Health Authority of Umbria, Department of Epidemiology
Paolo Eusebi
Affiliation:
Health Planning Service, Regional Health Authority of Umbria, Department of Epidemiology
Alessandro Montedori
Affiliation:
Health Planning Service, Regional Health Authority of Umbria, Department of Epidemiology
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Abstract

Objectives: In the past decade, there has been a growing interest in health technology disinvestment. A disinvestment process should involve all relevant stakeholders to identify and deliver the most effective, safe, and cost-effective healthcare interventions. The aim of the present study was to describe the state of the art of health technology disinvestment around the world and to identify parameters that could be associated with the implementation of disinvestment programs.

Methods: A systematic review of the literature was performed from database inception to November 2014, together with the collection of original data on socio-economic indicators from forty countries.

Results: Overall, 1,456 records (1,199 from electronic databases and 257 from other sources) were initially retrieved. After analyzing 172 full text articles, 38 papers describing fifteen disinvestment programs/experiences in eight countries were included. The majority (12/15) of disinvestment programs began after 2006. As expected, these programs were more common in developed countries, 63 percent of which had a Beveridge model healthcare system. The univariate analysis showed that countries with disinvestment programs had a significantly higher level of Human Development Index, Gross Domestic Product per capita, public expenditure on health and social services, life expectancy at birth and a lower level of infant mortality rate, and of perceived corruption. The existence of HTA agencies in the country was a strong predictor (p = .034) for the development of disinvestment programs.

Conclusions: The most significant variables in the univariate analysis were connected by a common factor, potentially related to the overall development stage of the country.

Keywords

DisinvestmentTechnology assessmentObsolescenceObsolete technologyOverview
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 33 , Issue 2 , 2017 , pp. 239 - 250
Copyright
Copyright © Cambridge University Press 2017 

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