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  • Laura Leggett (a1), Tom W. Noseworthy (a2), Mahmood Zarrabi (a3), Diane Lorenzetti (a4), Lloyd R. Sutherland (a2) and Fiona M. Clement (a2)...


Objectives: Obsolescence is a natural phase of the lifecycle of health technologies. Given increasing cost of health expenditures worldwide, health organizations have little choice but to engage in health technology reassessment (HTR); a structured, evidence-based assessment of the medical, social, ethical, and economic effects of a technology, currently used within the healthcare system, to inform optimal use of that technology in comparison to its alternatives. This research was completed to identify and summarize international HTR initiatives for non-drug technologies.

Methods: A systematic review was performed using the terms disinvestment, obsolescence, obsolete technology, ineffective, reassessment, reinvestment, reallocation, program budgeting, and marginal analysis to search PubMED, MEDLINE, EMBASE, and CINAHL until November 2011. Websites of organizations listed as members of INAHTA and HTAi were hand-searched for gray literature. Documents were excluded if they were unavailable in English, if the title/abstract was irrelevant to HTR, and/or if the document made no mention of current practices. All citations were screened in duplicate with disagreements resolved by consensus.

Results: Sixty full-text documents were reviewed and forty were included. One model for reassessment was identified; however, it has never been put into practice. Eight countries have some evidence of past or current work related to reassessment; seven have shown evidence of continued work in HTR. There is negligible focus on monitoring and implementation.

Conclusions: HTR is in its infancy. Although health technology reassessments are being conducted, there is no standardized approach. Future work should focus on developing and piloting a comprehensive methodology for completing HTR.



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1.Aspex Consulting. Victorian Department of Health Services: Review of the Victorian Policy Advisory Committee on Clinical Practice and Technology (VPACT). 2009. (accessed May 2012).
2.Avalia-t. PriTec tool for obsolete health technologies. 2011. (accessed May 2012).
3.Banta, HD, Thacker, SB. The case for reassessment of health care technology: Once is not enough. JAMA. 1990;264:235240.
4.Basque Office for HTA. Managing Obsolete Technologies and Disinvestment in the Basque Country's Health System. 2008. (accessed May 2012).
5.Center for Clinical Effectiveness. Health technology disinvestment: Tests, drugs and clinical practice. Report on a National Disinvestment Workshop. 2009. (accessed May 2012).
6.Center for Health Economics Research and Evaluation. Reducing the use of ineffective health care interventions. 2010. (accessed May 2012).
7.Chalkidou, K.The challenge of disinvestment. 2007. (accessed May 2012).
8.Elshaug, A.How do we stop paying for low-value care: Perspectives from initiatives in Australia. 2011. (accessed May 2012).
9.Elshaug, A.Identifying existing health care services that do not provide value for money. 2010. (accessed May 2012).
10.Elshaug, A.Improving allocation efficiencies in health care: Australian experience and future perspectives. 2011. (accessed May 2012).
11.Elshaug, A, Hiller, J, Tunis, S, Moss, J. Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Aust New Zealand Health Policy. 2007;4:23.
12.Elshaug, A, Moss, J, Karnon, J, Merlin, T, Hiller, J. Identifying existing health care services that do not provide value for money. MJA. 2009;190:269-73.
13.Elshaug, A, Watt, A, Moss, J, Hiller, J. Policy perspectives on the obsolescence of health technologies in Canada. 2009. (accessed May 2012).
14.Elshaug, AG, Hiller, JE, Moss, JR. Exploring policy-makers perspectives on disinvestment from ineffective healthcare practices. Int J Technol Assess Health Care. 2008;24:19.
15.Frellsen, MB, Kristensen, FB. Technologies that are claimed useless or applied in a useless way should undergo HTA and be discarded from daily practice if proven so. Case: routinely performed chest x-ray at admission. Ital J Public Health. 2005;2:65.
16.Garance, Franke-Ruta. Obama's Deficit Speech (Transcript). The Atlantic. 2011. (accessed May 2012).
17.Garner, S, Littlejohns, P. Disinvestment from low value clinical interventions: NICEly done? BMJ. 2011;343:d4519.
18.Greenberg, B, Derzon, RA. Determining health insurance coverage of technology: Problems and options. Med Care. 1981;19 967978.
19.Haas, M.Disinvestment: Breaking up is hard to do. 2011. (accessed May 2012).
20.Hughes, D, Ferner, R. New drugs for old: Disinvestment and NICE. BMJ. 2010;340:690692.
21.Ibargoyen, RN.Structuring the decision process for disinvestment. 2011 (accessed May 2012).
22.Ibargoyen-Roteta, N, Gutierrez-Ibarluzea, I, Asua, J. Report on the development of GuNFT guideline: Guideline for Not funding existing health technologies in health care systems. 2010. (accessed May 2012).
23.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;3:249254.
24.Ibargoyen-Roteta, N.Sources to identify potentially obsolete technologies. 2010. (accessed May 2012).
25.Ibargoyen-Roteta, N, Gutirrez-Ibarluzea, I, Asua, J. Guiding the process of health technology disinvestment. Health Policy. 2010;98:218226.
26.Jonsson, E. History of health technology assessment in Sweden. Int J Technol Assess Health Care. 2009;25 (Suppl S1):4252.
27.Joshi, N, Stahlnisch, F, Noseworthy, T. Reassessment of health technologies: Obsolescence and waste. 2009. (accessed May 2012).
28.Kale, M, Bishop, T, Federman, A, Keyhani, S. “Top 5” lists top $5 billion. Arch Intern Med. 2011;171 (20):1856-8.
29.Kelly, M. Public Health Programmes and Interventions and NHS Disinvestment. 2006. (accessed May 2012).
30.Medical Services Advisory Committee. Medical Services Advisory Committee: About us. 2011. (accessed May 2012).
31.Metropolitan Health and Aged Care Services Division. Future directions for health technology uptake, diffusion and disinvestment in Victorian public health services. Department of Human Services Workship Discussion Paper. 2007. (accessed May 2012).
32.Morland, B.Methods of no value must be abandoned. Tidsskr Nor Laegeforen. 2011;130:12561257.
33.Morland, B.Using HTAs to support disinvestment - The case of sleep apnoea (OSAS) in Norway. 2010. (accessed May 2012).
34.National Institute for Health and Clinical Excellence. How NICE guidance is helping the NHS through financial uncertainty. 2010. (accessed May 2012).
35.National Institute for Health and Clinical Excellence. How to use NICE guidance to commission high-quality services. 2010. (accessed May 2012).
36.National Institute for Health and Clinical Excellence. NICE ‘Do Not Do’ recommendations. 2011. (accessed May 2012).
37.Norwegien Ministry of Health. The Norwegian Council for Quality Improvement and Priority Setting in Health Care. 2010. (accessed May 2012).
38.Paulden, M.Investment and disinvestment of health technologies: Why CADTH ought to adopt two cost-effectiveness thresholds. 2011. (accessed May 2012).
39.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;12:160165.
40.Queensland Health. Health technology assessment in Queensland: Report 2009-2010. 2010. (accessed May 2012).
41.Ravina, A, Gonzalez, M, Lema, L, et al. Identification, prioritisation and assessment of obsolete health technologies: A methodological guideline. 2009. (accessed May 2012).
42.Robinson, S, Dickinson, H, Freeman, T, Williams, I. Disinvestment in health: The challenges facing general practitioner (GP) commissioners. Public Money Manage. 2011;31:145148.
43.Sage, D. Resource priority setting in health care: Formulating and implementing disinvestment health policy. The Quarterly. 2009;42:1518.
44.Scottish Health Technologies Group. Disinvestment - MaCSWise. 2011. (accessed May 2012).
45.Scottish Health Technologies Group. Final Report from Disinvestment Challenge Seminar: Making choices, spending wisely. 2010. (accessed May 2012).
46.Scottish Health Technologies Group (Health Improvement Scotland). What is the Scottish Health Technologies Group. 2009. (accessed May 2012).
47.Southern Health. Southern health: Evidence dissemination service. 2011. (accessed May 2012).
48.The Allen Consulting Group. Description of Selected health technology assessment processes: Health technology assessment in Western Australia. 2009.$File/allenreport.pdf (accessed May 2012).
50.Victoria Health. Victorian Policy Advisory Committee on Technology (VPACT): Terms of reference for role, function and governance. 2009. (accessed May 2012).
51.Williams, I, Robinson, S, Dickinson, H. Disinvestment. Cut with care. Health Serv J. 2011;121:2425.



  • Laura Leggett (a1), Tom W. Noseworthy (a2), Mahmood Zarrabi (a3), Diane Lorenzetti (a4), Lloyd R. Sutherland (a2) and Fiona M. Clement (a2)...


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