International Journal of Technology Assessment in Health Care

MINITHEME: DISINVESTMENT

USING HEALTH TECHNOLOGY ASSESSMENT TO SUPPORT OPTIMAL USE OF TECHNOLOGIES IN CURRENT PRACTICE: THE CHALLENGE OF “DISINVESTMENT”

Chris Henshalla1, Tara Schullera2 and Logan Mardhani-Baynea3 On behalf of the HTAi Policy Forum

a1 University of York email: consulting@chrishenshall.co.uk

a2 Health Technology Assessment International Secretariat

a3 Health Technology Assessment International Secretariat

Abstract

Background: Health systems face rising patient expectations and economic pressures; decision makers seek to enhance efficiency to improve access to appropriate care. There is international interest in the role of HTA to support decisions to optimize use of established technologies, particularly in “disinvesting” from low-benefit uses.

Methods: This study summarizes main points from an HTAi Policy Forum meeting on this topic, drawing on presentations, discussions among attendees, and an advance background paper.

Results and Conclusions: Optimization involves assessment or re-assessment of a technology, a decision on optimal use, and decision implementation. This may occur within a routine process to improve safety and quality and create “headroom” for new technologies, or ad hoc in response to financial constraints. The term “disinvestment” is not always helpful in describing these processes. HTA contributes to optimization, but there is scope to increase its role in many systems. Stakeholders may have strong views on access to technology, and stakeholder involvement is essential. Optimization faces challenges including loss aversion and entitlement, stakeholder inertia and entrenchment, heterogeneity in patient outcomes, and the need to demonstrate convincingly absence of benefit. While basic HTA principles remain applicable, methodological developments are needed better to support optimization. These include mechanisms for candidate technology identification and prioritization, enhanced collection and analysis of routine data, and clinician engagement. To maximize value to decision makers, HTA should consider implementation strategies and barriers. Improving optimization processes calls for a coordinated approach, and actions are identified for system leaders, HTA and other health organizations, and industry.

Keywords:

  • Disinvestment;
  • Technology assessment;
  • Biomedical;
  • Coverage;
  • Reimbursement

Footnotes

  The authors thank members and invited guests of the HTAi Policy Forum and members of the HTAi Board of Directors for their contributions to this paper, and acknowledge that funding to support development of this paper was provided by Health Technology Assessment International (HTAi).