Skip to main content


  • Ion Agirrezabal (a1), Joseph Burgon (a2), Gavin Stewart (a2) and Iñaki Gutierrez-Ibarluzea (a3)

Objectives: Disinvestment of existing healthcare technologies that deliver low or no health benefit for their cost can be used as a tool to improve access to effective technologies, while ensuring the long-term sustainability of healthcare systems. The objective of this research was to identify disinvestment initiatives in Latin American countries (LAC).

Methods: First, a systematic literature review (SLR) was conducted. In February 2015, MEDLINE, MEDLINE In-Process, EMBASE, The Cochrane Library, and LILACS were searched for relevant journal articles, including terms related to “disinvestment,” “reallocation,” “obsolete technologies,” and “Latin America.” Additionally, a manual search of documents from Latin American health technology assessment agencies was performed. Second, an online questionnaire was sent to experts in LAC to assess whether unpublished real-life disinvestment initiatives exist. Questionnaire results were collected in September 2015.

Results: From the SLR, 350 records were selected for screening following de-duplication and eleven articles fulfilled inclusion criteria. Only two of these reported information on initiatives potentially identifiable as disinvestment-investment activities in Brazil and Peru. Nine respondents completed the questionnaire, and four reported that disinvestment initiatives had been conducted in their respective organizations in Argentina, Brazil, and Mexico. This lack of agreement between the SLR and the questionnaire responses shows that disinvestment initiatives are ongoing, despite being under reported.

Conclusions: Many challenges need to be overcome for a disinvestment initiative to be successful, and sharing particular experiences with the international community would increase the chances of positive outcomes. The present study highlights the need for publication of such experiences in LAC.

Hide All
1. 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.
2. 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;110:180185.
3. Ibargoyen-Roteta, N, Gutierrez-Ibarluzea, I, Asua, J. Guiding the process of health technology disinvestment. Health Policy. 2010;98: 218226.
4. Ferri, CP. Population ageing in Latin America: Dementia and related disorders. Rev Bras Psiquiatr. 2012;34:371374.
5. Goss, PE, Lee, BL, Badovinac-Crnjevic, T, et al. Planning cancer control in Latin America and the Caribbean. Lancet Oncol. 2013;14:391436.
6. Rodriguez-Iturbe, B. Progress in the prevention of chronic kidney disease in Latin America. Nat Clin Pract Nephrol. 2008;4:233.
7. The Lancet Diabetes Endocrinology. Obesity prevention in Latin America: Now is the time. Lancet Diabetes Endocrinol. 2014;2:263.
8. Polisena, J, Clifford, T, Elshaug, AG, et al. Case studies that illustrate disinvestment and resource allocation decision-making processes in health care: A systematic review. Int J Technol Assess Health Care. 2013;29:174184.
9. Mitton, C, Dionne, F, Damji, R, Campbell, D, Bryan, S. Difficult decisions in times of constraint: Criteria based resource allocation in the Vancouver Coastal Health Authority. BMC Health Serv Res. 2011;11:169.
10. Blaya, JA, Gomez, W, Rodriguez, P, Fraser, H. Cost and implementation analysis of a personal digital assistant system for laboratory data collection. Int J Tuberc Lung Dis. 2008;12:921927.
11. Kilsztajn, S, Lopes Ede, S, Lima, LZ, Rocha, PA, Carmo, MS. [Hospital beds and mental health reform in Brazil]. Cad Saude Publica. 2008;24:23542362.
12. Caires de Souza, AL, de Assis Acurcio, F, Guerra Junior, AA, et al. Insulin glargine in a Brazilian state: Should the government disinvest? An assessment based on a systematic review. Appl Health Econ Health Policy. 2014;12:1932.
13. Capucho, H, Mastroianni, P, Cuffini, S. Farmacovigilância no Brasil: A relação entre polimorfi smo de fármacos, efetividade e segurança dos medicamentos. Rev Ciênc Farm Básica Apl. 2008;29:277283.
14. Colomar, M, Belizan, M, Cafferata, ML, et al. [Practices of maternal and perinatal care performed in public hospitals of Uruguay]. Ginecol Obstet Mex. 2004;72:455465.
15. Conde-Agudelo, A, Rosas-Bermudez, A, Gulmezoglu, AM. Evidence-based intrapartum care in Cali, Colombia: A quantitative and qualitative study. BJOG. 2008;115:15471556.
16. de Souza, AL, Acurcio Fde, A, Guerra Junior, AA, et al. Authors' reply to Dr. Malerbi: “Insulin glargine in a Brazilian state: Should the government disinvest?”. Appl Health Econ Health Policy. 2014;12: 561563.
17. Malerbi, DA. Comment on: “Insulin glargine in a Brazilian state: Should the government disinvest?”. Appl Health Econ Health Policy. 2014;12:559560.
18. Calderon, RB, Depine, S. Sustainable and tenable renal health model: A Latin American proposal of classification, programming, and evaluation. Kidney Int Suppl. 2005:S23S30.
19. Nobre, FF, Trotta, LT, Gomes, LF. Multi-criteria decision making–an approach to setting priorities in health care. Stat Med. 1999;18:33453354.
20. Vargas-Lagos, V. How should resources be reallocated between physicians and nurses in Africa and Latin America? Soc Sci Med. 1991;33:723727.
21. Rubinstein, A, Pichon-Riviere, A, Augustovski, F. Development and implementation of health technology assessment in Argentina: Two steps forward and one step back. Int J Technol Assess Health Care. 2009;25 (Suppl 1):260269.
22. Lovato-Pires de Lemos, L, Alvares, J, Resende-Faleiros, D, et al. Methodological guideline for disinvestment in Brazil. CCATES. 2015. (accessed October 20, 2016).
23. Elshaug, AG, Watt, AM, Moss, JR, Hiller, JE. Policy perspectives on the obsolescence of health technologies in Canada. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2009.
24. International Monetary Fund. Growth in Latin America weakens for fifth year in a row. 2015. (accessed August 15, 2015).
25. World Bank. Latin America and Caribbean overview. 2015. (accessed August 15, 2016).
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Type Description Title
Supplementary materials

Agirrezabal et al supplementary mateirial 1
Supplementary Table

 Word (17 KB)
17 KB


Altmetric attention score