Health Planning Service,Regional Health Authority of Umbria,Department of
Catholic University of the Sacred Heart,Institute of Public Health.
Int J Technol Assess Health Care. 2017 Jan;33(2):239-250. doi: 10.1017/S0266462317000514. Epub 2017 Jul 3.
In the past decade, there has been a growing interest in health technology disinvestment. A disinvestment process should involve all relevant stakeholders to identify and deliver the most effective, safe, and cost-effective healthcare interventions. The aim of the present study was to describe the state of the art of health technology disinvestment around the world and to identify parameters that could be associated with the implementation of disinvestment programs.
A systematic review of the literature was performed from database inception to November 2014, together with the collection of original data on socio-economic indicators from forty countries.
Overall, 1,456 records (1,199 from electronic databases and 257 from other sources) were initially retrieved. After analyzing 172 full text articles, 38 papers describing fifteen disinvestment programs/experiences in eight countries were included. The majority (12/15) of disinvestment programs began after 2006. As expected, these programs were more common in developed countries, 63 percent of which had a Beveridge model healthcare system. The univariate analysis showed that countries with disinvestment programs had a significantly higher level of Human Development Index, Gross Domestic Product per capita, public expenditure on health and social services, life expectancy at birth and a lower level of infant mortality rate, and of perceived corruption. The existence of HTA agencies in the country was a strong predictor (p = .034) for the development of disinvestment programs.
The most significant variables in the univariate analysis were connected by a common factor, potentially related to the overall development stage of the country.
在过去十年中，人们对医疗技术撤资越来越感兴趣。撤资过程应涉及所有相关利益攸关方，以确定并提供最有效、安全和具有成本效益的医疗干预措施。本研究的目的是描述全球范围内医疗技术撤资的现状，并确定可能与撤资计划实施相关的参数。
从数据库建立到 2014 年 11 月，对文献进行了系统回顾，并从 40 个国家收集了社会经济指标的原始数据。
总共检索到 1456 条记录（1199 条来自电子数据库，257 条来自其他来源）。在分析了 172 篇全文文章后，纳入了 38 篇描述 8 个国家 15 个撤资计划/经验的论文。大多数（15 个中的 12 个）撤资计划是在 2006 年后开始的。正如预期的那样，这些计划在发达国家更为常见，其中 63%的国家实行贝弗里奇模式的医疗保健系统。单变量分析显示，实施撤资计划的国家人类发展指数、人均国内生产总值、公共卫生和社会服务支出、出生时预期寿命以及婴儿死亡率都显著较高，而感知到的腐败程度较低。国家是否存在 HTA 机构是发展撤资计划的一个强有力预测因素（p =.034）。
单变量分析中最重要的变量由一个共同因素联系在一起，这个因素可能与国家的整体发展阶段有关。
