Calabrò G E, La Torre G, de Waure C, Villari P, Federici A, Ricciardi W, Specchia M L
Institute of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Roma, Italy.
Department of Public Health and Infectious Diseases, Sapienza Università di Roma, Rome, Italy.
BMC Health Serv Res. 2018 Mar 1;18(1):148. doi: 10.1186/s12913-018-2941-0.
In an era of a growing economic pressure for all health systems, the interest for "disinvestment" in healthcare increased. In this context, evidence based approaches such as Health Technology Assessment (HTA) are needed both to invest and to disinvest in health technologies. In order to investigate the extent of application of HTA in this field, methodological projects/frameworks, case studies, dissemination initiatives on disinvestment released by HTA agencies and organizations located in Europe were searched.
In July 2015, the websites of HTA agencies and organizations belonging to the European network for HTA (EUnetHTA) and the International Network of Agencies for HTA (INAHTA) were accessed and searched through the use of the term "disinvestment". Retrieved deliverables were considered eligible if they reported methodological projects/frameworks, case studies and dissemination initiatives focused on disinvestment in healthcare.
62 HTA agencies/organizations were accessed and eight methodological projects/frameworks, one case study and one dissemination initiative were found starting from 2007. With respect to methodological projects/frameworks, two were delivered in Austria, one in Italy, two in Spain and three in U.K. As for the case study and the dissemination initiative, both came from U.K. The majority of deliverables were aimed at making an overview of existing disinvestment approaches and at identifying challenges in their introduction.
Today, in a healthcare context characterized by resource scarcity and increasing service demand, "disinvestment" from low-value services and reinvestment in high-value ones is a key strategy that may be supported by HTA. The lack of evaluation of technologies in use, in particular at the end of their lifecycle, may be due to the scant availability of frameworks and guidelines for identification and assessment of obsolete technologies that was shown by our work. Although several projects were carried out in different countries, most remain constrained to the field of research. Disinvestment is a relatively new concept in HTA that could pose challenges also from a methodological point of view. To tackle these challenges, it is necessary to construct experiences at international level with the aim to develop new methodological approaches to produce and grow evidence on disinvestment policies and practices.
在所有卫生系统面临经济压力不断增大的时代，医疗保健领域“撤资”的关注度有所上升。在此背景下，诸如卫生技术评估（HTA）等基于证据的方法对于卫生技术的投资和撤资均十分必要。为了调查HTA在该领域的应用程度，检索了欧洲的HTA机构和组织发布的关于撤资的方法学项目/框架、案例研究及传播举措。
2015年7月，访问了欧洲卫生技术评估网络（EUnetHTA）和国际卫生技术评估机构网络（INAHTA）所属的HTA机构和组织的网站，并通过搜索“撤资”一词进行检索。如果检索到的成果报告了侧重于医疗保健撤资的方法学项目/框架、案例研究及传播举措，则将其视为符合条件。
访问了62个HTA机构/组织，自2007年起共找到8个方法学项目/框架、1个案例研究和1个传播举措。关于方法学项目/框架，2个由奥地利提供，1个由意大利提供，2个由西班牙提供，3个由英国提供。至于案例研究和传播举措，均来自英国。大多数成果旨在概述现有的撤资方法，并确定引入这些方法时面临的挑战。
如今，在资源稀缺且服务需求不断增加的医疗保健背景下，从低价值服务中“撤资”并对高价值服务进行再投资是一项关键战略，可能会得到HTA的支持。对在用技术缺乏评估，尤其是在其生命周期结束时，可能是由于我们的研究表明，识别和评估过时技术的框架和指南很少。尽管在不同国家开展了多个项目，但大多数仍局限于研究领域。撤资在HTA中是一个相对较新的概念，从方法学角度来看也可能带来挑战。为应对这些挑战，有必要在国际层面积累经验，以开发新的方法学方法，为撤资政策和实践提供并增加证据。
