Hostname: page-component-745bb68f8f-mzp66 Total loading time: 0 Render date: 2025-01-11T00:41:09.214Z Has data issue: false hasContentIssue false
  • English
  • Français

HEALTH TECHNOLOGY REASSESSMENT OF NON-DRUG TECHNOLOGIES: CURRENT PRACTICES

Published online by Cambridge University Press:  14 September 2012

Laura Leggett ,
Tom W. Noseworthy ,
Mahmood Zarrabi ,
Diane Lorenzetti ,
Lloyd R. Sutherland  and
Fiona M. Clement
Laura Leggett
Affiliation:
University of Calgary; Institute of Public Health, Calgary email: lelegget@ucalgary.ca
Tom W. Noseworthy
Affiliation:
University of Calgary; Institute of Public Health, Calgary
Mahmood Zarrabi
Affiliation:
Alberta Health Services
Diane Lorenzetti
Affiliation:
University of Calgary
Lloyd R. Sutherland
Affiliation:
University of Calgary; Institute of Public Health, Calgary
Fiona M. Clement
Affiliation:
University of Calgary; Institute of Public Health, Calgary
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Keywords

Technology assessmentBiomedicalHealth services researchBiomedical technologyHealth planning
Type
MINITHEME: DISINVESTMENT
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 3 , July 2012 , pp. 220 - 227
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Aspex Consulting. Victorian Department of Health Services: Review of the Victorian Policy Advisory Committee on Clinical Practice and Technology (VPACT). 2009. http://www.health.vic.gov.au/newtech/documents/vpact_final_review.pdf (accessed May 2012).Google Scholar
2.Avalia-t. PriTec tool for obsolete health technologies. 2011. http://pritectools.es/Controlador/documentosAction.php?idioma=en (accessed May 2012).Google Scholar
3.Banta, HD, Thacker, SB. The case for reassessment of health care technology: Once is not enough. JAMA. 1990;264:235–240.CrossRefGoogle ScholarPubMed
4.Basque Office for HTA. Managing Obsolete Technologies and Disinvestment in the Basque Country's Health System. 2008. http://aunets.isciii.es/ficherosproductos/92/Obsolete%20technologies%20and%20disinvestment.pdf (accessed May 2012).Google Scholar
5.Center for Clinical Effectiveness. Health technology disinvestment: Tests, drugs and clinical practice. Report on a National Disinvestment Workshop. 2009. http://www.southernhealth.org.au/icms_docs/3337_Disinvestment_Workshop_Report_Part_1.pdf (accessed May 2012).Google Scholar
6.Center for Health Economics Research and Evaluation. Reducing the use of ineffective health care interventions. 2010. http://www.chere.uts.edu.au/pdf/wp2010_5.pdf (accessed May 2012).Google Scholar
7.Chalkidou, K.The challenge of disinvestment. 2007. http://www.slideshare.net/Maxisurgeon/the-challenge-of-disinvestment (accessed May 2012).Google Scholar
8.Elshaug, A.How do we stop paying for low-value care: Perspectives from initiatives in Australia. 2011. http://www.ispor.org/meetings/baltimore0511/presentations/IP7_Adam-Elshaug-Slides.pdf (accessed May 2012).Google Scholar
9.Elshaug, A.Identifying existing health care services that do not provide value for money. 2010. http://www.ihe.ca/documents/Elshaug_IHE%20Edmonton_April2010.pdf (accessed May 2012).Google Scholar
10.Elshaug, A.Improving allocation efficiencies in health care: Australian experience and future perspectives. 2011. http://www.chsrf.ca/Libraries/CEO_Forum_files/ElshaugENG.sflb.ashx (accessed May 2012).Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
13.Elshaug, A, Watt, A, Moss, J, Hiller, J. Policy perspectives on the obsolescence of health technologies in Canada. 2009. http://www.cadth.ca/media/policy_forum_section/Obsolescence%20of%20Health%20Technologies%20in%20Canada_Policy_Forum_e.pdf (accessed May 2012).Google Scholar
14.Elshaug, AG, Hiller, JE, Moss, JR. Exploring policy-makers perspectives on disinvestment from ineffective healthcare practices. Int J Technol Assess Health Care. 2008;24:1–9.CrossRefGoogle ScholarPubMed
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.Google Scholar
16.Garance, Franke-Ruta. Obama's Deficit Speech (Transcript). The Atlantic. 2011. http://www.theatlantic.com/politics/archive/2011/04/obamas-deficit-speech-transcript/237274/ (accessed May 2012).Google Scholar
17.Garner, S, Littlejohns, P. Disinvestment from low value clinical interventions: NICEly done? BMJ. 2011;343:d4519.CrossRefGoogle Scholar
18.Greenberg, B, Derzon, RA. Determining health insurance coverage of technology: Problems and options. Med Care. 1981;19 967–978.CrossRefGoogle ScholarPubMed
19.Haas, M.Disinvestment: Breaking up is hard to do. 2011. http://www.hpm.org/Downloads/Symposium_2010/4-1_Haas_Disinvestments_-_Barriers_of_implementation.pdf (accessed May 2012).Google Scholar
20.Hughes, D, Ferner, R. New drugs for old: Disinvestment and NICE. BMJ. 2010;340:690–692.CrossRefGoogle ScholarPubMed
21.Ibargoyen, RN.Structuring the decision process for disinvestment. 2011 http://www.htai.org/fileadmin/HTAi_Files/ISG/Disinvestment/StructuringTheDecisionProcessForDisinvestment-NoraIbargoyen-Roteta.pdf (accessed May 2012).Google Scholar
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. http://www9.euskadi.net/sanidad/osteba/datos/e_10_11_report_GuNFT.pdf (accessed May 2012).Google Scholar
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;3:249–254.CrossRefGoogle Scholar
24.Ibargoyen-Roteta, N.Sources to identify potentially obsolete technologies. 2010. http://www.htai.org/fileadmin/HTAi_Files/ISG/Disinvestment/Sources%20for%20Identifying%20Obsolete%20Technologies%20-%20Nora%20Ibargoyen-Roteta.pdf (accessed May 2012).Google Scholar
25.Ibargoyen-Roteta, N, Gutirrez-Ibarluzea, I, Asua, J. Guiding the process of health technology disinvestment. Health Policy. 2010;98:218–226.CrossRefGoogle ScholarPubMed
26.Jonsson, E. History of health technology assessment in Sweden. Int J Technol Assess Health Care. 2009;25 (Suppl S1):42–52.CrossRefGoogle ScholarPubMed
27.Joshi, N, Stahlnisch, F, Noseworthy, T. Reassessment of health technologies: Obsolescence and waste. 2009. http://www.cadth.ca/media/pdf/494_Reassessment_of_HT_Obsolescence_and_Waste_tr_e.pdf (accessed May 2012).Google Scholar
28.Kale, M, Bishop, T, Federman, A, Keyhani, S. “Top 5” lists top $5 billion. Arch Intern Med. 2011;171 (20):1856-8.CrossRefGoogle Scholar
29.Kelly, M. Public Health Programmes and Interventions and NHS Disinvestment. 2006. http://www.nice.org.uk/niceMedia/pdf/smt/040406item5.pdf (accessed May 2012).Google Scholar
30.Medical Services Advisory Committee. Medical Services Advisory Committee: About us. 2011. http://www.msac.gov.au/internet/msac/publishing.nsf/Content/about-us-lp-1 (accessed May 2012).Google Scholar
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. http://www.health.vic.gov.au/newtech/documents/new-tech-workshop-discussion.pdf (accessed May 2012).Google Scholar
32.Morland, B.Methods of no value must be abandoned. Tidsskr Nor Laegeforen. 2011;130:1256–1257.Google Scholar
33.Morland, B.Using HTAs to support disinvestment - The case of sleep apnoea (OSAS) in Norway. 2010. http://www.isqua.org/Uploads/Conference/Abstracts/B_MORLAND.pdf.p (accessed May 2012).Google Scholar
34.National Institute for Health and Clinical Excellence. How NICE guidance is helping the NHS through financial uncertainty. 2010. http://www.nice.org.uk/newsroom/news/newsarchive/2009/howniceguidanceishelpingthenhsthroughfinancialuncertainty.jsp (accessed May 2012).Google Scholar
35.National Institute for Health and Clinical Excellence. How to use NICE guidance to commission high-quality services. 2010. http://www.nice.org.uk/media/027/17/HowToCommissioningGuideFinal.pdf (accessed May 2012).Google Scholar
36.National Institute for Health and Clinical Excellence. NICE ‘Do Not Do’ recommendations. 2011. http://www.nice.org.uk/usingguidance/donotdorecommendations/ (accessed May 2012).Google Scholar
37.Norwegien Ministry of Health. The Norwegian Council for Quality Improvement and Priority Setting in Health Care. 2010. http://www.kvalitetogprioritering.no/R%C3%A5det/About+us (accessed May 2012).Google Scholar
38.Paulden, M.Investment and disinvestment of health technologies: Why CADTH ought to adopt two cost-effectiveness thresholds. 2011. http://theta.utoronto.ca/?9371 (accessed May 2012).Google Scholar
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;12:160–165.CrossRefGoogle ScholarPubMed
40.Queensland Health. Health technology assessment in Queensland: Report 2009-2010. 2010. http://www.health.qld.gov.au/newtech/docs/htaqld_rpt.pdf (accessed May 2012).Google Scholar
41.Ravina, A, Gonzalez, M, Lema, L, et al. Identification, prioritisation and assessment of obsolete health technologies: A methodological guideline. 2009. http://www.sergas.es/docs/Avalia-t/ObsoleteTechMemFinal.pdf (accessed May 2012).Google Scholar
42.Robinson, S, Dickinson, H, Freeman, T, Williams, I. Disinvestment in health: The challenges facing general practitioner (GP) commissioners. Public Money Manage. 2011;31:145–148.CrossRefGoogle Scholar
43.Sage, D. Resource priority setting in health care: Formulating and implementing disinvestment health policy. The Quarterly. 2009;42:15–18.Google Scholar
44.Scottish Health Technologies Group. Disinvestment - MaCSWise. 2011. http://www.healthcareimprovementscotland.org/default.aspx?page=13413 (accessed May 2012).Google Scholar
45.Scottish Health Technologies Group. Final Report from Disinvestment Challenge Seminar: Making choices, spending wisely. 2010. http://www.healthcareimprovementscotland.org/default.aspx?page=12761 (accessed May 2012).Google Scholar
46.Scottish Health Technologies Group (Health Improvement Scotland). What is the Scottish Health Technologies Group. 2009. http://www.healthcareimprovementscotland.org/programmes/clinical__cost_effectiveness/shtg.aspx (accessed May 2012).Google Scholar
47.Southern Health. Southern health: Evidence dissemination service. 2011. http://www.southernhealth.org.au/page/Health_Professionals/CCE/Services/Evidence_Dissemination_Service/ (accessed May 2012).Google Scholar
48.The Allen Consulting Group. Description of Selected health technology assessment processes: Health technology assessment in Western Australia. 2009. http://www.health.gov.au/internet/main/publishing.nsf/Content/A178353541601D3FCA2575580012448F/$File/allenreport.pdf (accessed May 2012).Google Scholar
49.Towler, S. Governments and technology vantage points. 2009. http://www.himaa.org.au/2009/site/proceedings/Conference%20Presentations%202009/Day%201%20-%20October%2014%20-%20Wednesday/PPT%20Shows/1_Simon_Towler.pps. (accessed May 2012).Google Scholar
50.Victoria Health. Victorian Policy Advisory Committee on Technology (VPACT): Terms of reference for role, function and governance. 2009. http://www.health.vic.gov.au/newtech/documents/vpact_tor.pdf (accessed May 2012).Google Scholar
51.Williams, I, Robinson, S, Dickinson, H. Disinvestment. Cut with care. Health Serv J. 2011;121:24–25.Google ScholarPubMed