University of Calgary; Institute of Public Health, Calgary, Alberta, Canada.
Int J Technol Assess Health Care. 2012 Jul;28(3):220-7. doi: 10.1017/S0266462312000438.
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.
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.
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.
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.
淘汰是医疗技术生命周期的自然阶段。鉴于全球医疗支出成本不断增加，卫生组织别无选择，只能进行医疗技术重新评估（HTR）；这是对当前在医疗保健系统中使用的技术的医疗、社会、伦理和经济影响进行的一种结构化、基于证据的评估，旨在告知该技术与替代技术相比的最佳使用方式。这项研究的目的是确定和总结非药物技术的国际 HTR 计划。
使用术语废弃、过时、过时技术、无效、重新评估、再投资、重新分配、项目预算和边际分析，对 PubMED、MEDLINE、EMBASE 和 CINAHL 进行系统评价，直到 2011 年 11 月。对 INAHTA 和 HTAi 成员组织的网站进行手工搜索，以获取灰色文献。如果文件不可用英文获取、标题/摘要与 HTR 无关、或文件未提及当前做法，则将其排除在外。所有引文均进行了双重筛选，分歧通过共识解决。
共审查了 60 篇全文文件，其中 40 篇被纳入。确定了一种重新评估的模型；然而，它从未付诸实践。有 8 个国家有一些与重新评估相关的过去或当前工作的证据；其中 7 个国家在 HTR 方面显示出持续工作的证据。几乎没有关注监测和实施。
HTR 仍处于起步阶段。虽然已经进行了医疗技术重新评估，但没有标准化的方法。未来的工作应侧重于开发和试点用于完成 HTR 的综合方法。
