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DRUG DISINVESTMENT FRAMEWORKS: COMPONENTS, CHALLENGES, AND SOLUTIONS

Published online by Cambridge University Press:  13 July 2017

Mary Alison Maloney ,
Lisa Schwartz ,
Daria O'Reilly  and
Mitchel Levine
Mary Alison Maloney
Affiliation:
Department of Health Research Methods, Evidence, and Impact (formerly “Clinical Epidemiology and Biostatistics), McMaster UniversityBayer HealthCare LLCalison_maloney@optimum.net
Lisa Schwartz
Affiliation:
Department of Health Research Methods, Evidence, and Impact (formerly “Clinical Epidemiology and Biostatistics”)Centre for Health Economics and Policy Analysis, McMaster University
Daria O'Reilly
Affiliation:
Department of Health Research Methods, Evidence, and Impact (formerly “Clinical Epidemiology and Biostatistics”), McMaster University Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton
Mitchel Levine
Affiliation:
Department of Health Research Methods, Evidence, and Impact (formerly “Clinical Epidemiology and Biostatistics”), McMaster University Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton
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Abstract

Objectives: Value assessments of marketed drug technologies have been developed through disinvestment frameworks. Components of these frameworks are varied and implementation challenges are prevalent. The objective of this systematic literature review was to describe disinvestment framework process components for drugs and to report on framework components, challenges, and solutions.

Methods: A systematic literature search was conducted using the terms: reassessment, reallocation, reinvestment, disinvestment, delist, decommission or obsolescence in MEDLINE, EMBASE, NLM PubMed, the Cochrane Library, and CINAHL from January 1, 2000, until November 14, 2015. Additional citations were identified through a gray literature search of Health Technology Assessment international (HTAi) and the International Network of Agencies for Health Technology Assessment (INAHTA) member Web sites and from bibliographies of full-text reviewed manuscripts.

Results: Sixty-three articles underwent full text review and forty were included in the qualitative analysis. Framework components including disinvestment terms and definitions, identification and prioritization criteria and methods, assessment processes, stakeholders and dissemination strategies, challenges, and solutions were compiled. This review finds that stakeholders lack the political, administrative, and clinical will to support disinvestment and that there is not one disinvestment framework that is considered best practice.

Conclusions: Drug technology disinvestment components and processes vary and challenges are numerous. Future research should focus on lessening value assessment challenges. This could include adopting more neutral framework terminology, setting fixed reassessment timelines, conducting therapeutic reviews, and modifying current qualitative decision-making assessment frameworks.

Keywords

Technology assessmentDisinvestmentBudgetsReassessment
Type
Policies
Information
International Journal of Technology Assessment in Health Care , Volume 33 , Issue 2 , 2017 , pp. 261 - 269
Copyright
Copyright © Cambridge University Press 2017 

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References

REFERENCES

1. Garner, S, Littlejohns, P. Disinvestment from low value clinical interventions: NICEly done? BMJ. 2011;343:d4519.CrossRefGoogle Scholar
2. MacKean, G, Noseworthy, T, Elshaug, AG, et al. Health technology reassessment: The art of the possible. Int J Technol Assess Health Care. 2013;29:418-423.CrossRefGoogle ScholarPubMed
3. Moher, D, Liberati, A, Tetzlaff, J, Group, Altman DG; PRISMA. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med. 2009;151:264-269. W64.CrossRefGoogle ScholarPubMed
4. Elshaug, AG, Hiller, J, Tunis, SR, 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
5. Gnjidic, D, Elshaug, AG. De-adoption and its 43 related terms: Harmonizing low-value care terminology. BMC Med. 2015;13:273.CrossRefGoogle ScholarPubMed
6. Ibargoyen-Roteta, N, Gutierrez-Ibarluzea, I, Asua, J. Guiding the process of health technology disinvestment. Health Policy. 2010;98:218-226.CrossRefGoogle ScholarPubMed
7. Parkinson, B, Sermet, C, Clement, F, et al. Disinvestment and value-based purchasing strategies for pharmaceuticals: An international review. Pharmacoeconomics. 2015;33:905-924.CrossRefGoogle ScholarPubMed
8. Wilson, MG, Ellen, ME, Lavis, JN, et al. Processes, contexts, and rationale for disinvestment: A protocol for a critical interpretive synthesis. Syst Rev. 2014;3:143.CrossRefGoogle ScholarPubMed
9. Elshaug, AG, Moss, J, Littlejohns, P, Karnon, J, Merlin, T, Hiller, J. Identifying existing health care services that do not provide value for money. Med J Aust. 2009;190:269-373.CrossRefGoogle Scholar
10. Gerdvilaite, J, Nachtnebel, A. Disinvestment: Overview of disinvestment experiences and challenges in selected countries. 2011. http://eprints.hta.lbg.ac.at/926/# (accessed January 30, 2016).Google Scholar
11. Healthcare Improvement Scotland. Technologies scoping report. 2013. http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/earlier_scoping_reports/technologies_scoping_report_16.aspx (accessed January 31, 2016).Google Scholar
12. Alberta Health Services. Reassessment Program. 2016. http://www.albertahealthservices.ca/info/Page4144.aspx (accessed January 30, 2016).Google Scholar
13. Health Policy Advisory Committee on Technology. Disinvestment in Australia and New Zealand. Australia: Queensland Health; 2013.Google Scholar
14. Elshaug, AG, Hiller, J, Moss, J. Exploring policy-makers' perspectives on disinvestment from ineffective healthcare practices. Int J Technol Assess Health Care. 2008;24:1-9.CrossRefGoogle ScholarPubMed
15. Morland, B. Methods of no value must be abandoned. Tidsskr Nor Laegeforen. 2010;130:1256-1257.Google ScholarPubMed
16. Ruano Ravina, A, Velasco Gonzalez, M, Varela Lema, L, et al. Identification, prioritisation and assessment of obsolete health technologies. A methodological guideline. Santiago de ComPostela: Galician Agency for Health Technology Assessment (AVALIA-T); 2007.Google Scholar
17. Joshi, N, Stahlnisch, F, Noseworthy, T. Reassessment of heath technologies: Obsolescence and waste. 2009. http://www.cadth.ca/reassessment-health-technologies-obsolescence-and-waste (accessed February 6, 2016).Google Scholar
18. Albert Health Services. Health Technology Assessment & Innovation Department Annual Report (April 1, 2010 - March 31, 2011). 2011. http://www.albertahealthservices.ca/assets/Infofor/Researchers/if-res-htai-annual-report.pdf (accessed January 30, 2016).Google Scholar
19. Garner, S, Docherty, M, Somner, J, et al. Reducing ineffective practice: Challenges in identifying low-value health care using Cochrane systematic reviews. J Health Serv Res Policy. 2013;18:6-12.CrossRefGoogle ScholarPubMed
20. Hughes, D, Ferner, R. New drugs for old: Disinvestment and NICE. BMJ. 2010;340:c572.CrossRefGoogle ScholarPubMed
21. Haas, M, Hall, J, Viney, R, Gallego, G. Breaking up is hard to do: Why disinvestment in medical technology is harder than investment. Aust Health Rev. 2012;36:148-152.CrossRefGoogle Scholar
22. Health Quality Ontario. Appropriateness initiative. 2014. http://www.hqontario.ca/Evidence/Evidence-Process/Appropriateness-Initiative (accessed January 30, 2016).Google Scholar
23. 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;110:180-185.CrossRefGoogle ScholarPubMed
24. 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
25. Scottish Health Technologies Group. Scottish health technologies group development day 2013. 2013. http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg/about_the_group/shtg_development_day_2013.aspx (accessed January 31, 2016).Google Scholar
26. Henshall, C, Schuller, T, Mardhani-Bayne, L. Using health technology assessment to support optimal use of technologies in current practice: The challenge of “disinvestment”. Int J Technol Assess Health Care. 2012;28:203-210.CrossRefGoogle ScholarPubMed
27. Paprica, A, Culyer, A, Elshaug, A, Peffer, J, Sandoval, G. From talk to action: Policy stakeholders, appropriateness, and selective disinvestment. Int J Technol Assess Health Care. 2015;31:236-240.CrossRefGoogle ScholarPubMed
28. 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;25:249-254.CrossRefGoogle ScholarPubMed
29. Polisena, J, Clifford, T, Elshaug, AG, Mitton, C, Russell, E, Skidmore, B. Case studies that illustrate disinvestment and resource allocation decision-making processes in health care: A systematic review. Int J Technol Assess Health Care. 2013;29:174-184.CrossRefGoogle ScholarPubMed
30. Goodman, C. HTA 101: Introduction to Health Technology Assessment. http://www.nlm.nih.gov/nichsr/hta101.pdf (accessed December 19, 2015).Google Scholar
31. Noseworthy, T, Clement, F. Health technology reassessment: Scope, methodology, & language. Int J Technol Assess Health Care. 2012;28:201-202.CrossRefGoogle ScholarPubMed
32. Elshaug, A, Watt, A, Moss, J, Hiller, J. Policy perspectives on the obsolescence of health technologies in Canada. 2009. http://www.cadth.ca/collaboration-and-outreach/advisory-bodies/policy-forum/discussion-papers/policy-perspectives-obsolescence-health (accessed February 6, 2016).Google Scholar
33. European Medicines Agency. Benefit-risk methodology project. Work package 4 report: Benefit-risk tools and processes. 2012. http://www.ema.europa.eu/docs/en_GB/document_library/Report/2012/03/WC500123819.pdf (accessed October 12, 2016).Google Scholar
34. US Food and Drug Administration. PDUFA re-authorisation performance goals and procedures fiscal years 2013 through 2017. 2012. http://www.fda.gov/downloads/ForIndustry/UserFees/PrescriptionDrugUserFee/UCM270412.pdf (accessed October 14, 2016).Google Scholar
35. Haines, T, O'Brien, L, McDermott, F, et al. A novel research design can aid disinvestment from existing health technologies with uncertain effectiveness, cost-effectiveness, and/or safety. J Clin Epidemiol. 2014;67:144-151.1 CrossRefGoogle ScholarPubMed
36. Moynihan, RN. A healthy dose of disinvestment. Med J Aust. 2012;196:158.CrossRefGoogle ScholarPubMed
37. Watt, AM, Hiller, JE, Braunack-Mayer, AJ, et al. The ASTUTE health study protocol: Deliberative stakeholder engagements to inform implementation approaches to healthcare disinvestment. Implement Sci. 2012;7:101.CrossRefGoogle ScholarPubMed
38. Ibargoyen-Roteta, N, Gutierrez-Ibarluzea, I, Asua, J. Report on the development of the GuNFT guideline. Guideline for not funding existing health technologies in health care systems. 2007. http://www9.euskadi.net/sanidad/osteba/datos/e_10_11_report_GuNFT.pdf (accessed January 31, 2016).Google Scholar
39. Fenwick, E, Claxton, K, Sculpher, M, Briggs, A. Improving the efficiency and relevance of health technology assessment: The role of iterative decision analytic modelling. 2000. https://www.york.ac.uk/che/pdf/DP179.pdf (accessed January 31, 2016).Google Scholar
40. Hollingworth, W, Chamberlain, C. NICE recommendations for disinvestment. BMJ. 2011;343:d5772.CrossRefGoogle ScholarPubMed
41. Jaurlaritza, IE. HTAI summit examines disinvestment and the most cost-effective ways to manage current health technology. 2012. http://www.irekia.euskadi.eus/en/news/11317-htai-summit-examines-disinvestment-and-the-most-cost-effective-ways-manage-current-health-technology (accessed January 16, 2016).Google Scholar
42. Scottish Health Technologies Group. Making choices spending wisely (MaCSWise) A report of current practice in NHSScotland relating to National Institute of Health and Clinical Excellence cost-saving recommendations. 2012. http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_ad_hoc/macswise_report.aspx (accessed February 6, 2016).Google Scholar
43. Watt, AM, Willis, CD, Hodgetts, K, Elshaug, AG, Hiller, JE. Engaging clinicians in evidence-based disinvestment: Role and perceptions of evidence. Int J Technol Assess Health Care. 2012;28:211-219.CrossRefGoogle ScholarPubMed
44. Mayer, J, Nachtnebel, A. Identification of ineffective interventions and technologies: Existing models and their implementation. 2013. http://eprints.hta.lbg.ac.at/1014/ (accessed February 7, 2016).Google Scholar
45. O'Callaghan, G, Meyer, H, Elshaug, AG. Choosing wisely: The message, messenger and method. Med J Aust. 2015;202:175-177.CrossRefGoogle ScholarPubMed
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