Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
Malaysian Health Technology Assessment Section, Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia.
Int J Technol Assess Health Care. 2022 Jul 20;38(1):e69. doi: 10.1017/S0266462322000514.
Disinvestment from low value health technologies is growing globally. Diverse evidence gathering and assessment methods were used to implement disinvestment initiatives, however, less than half of the empirical studies report reduced use of the low-value services. This scoping review aimed to synthesize the information from available reviews on the concepts and purposes of disinvestment in healthcare, the approaches and methods used, the role of stakeholders and facilitators and barriers in its implementation.
This scoping review was guided by the Joanna Briggs Institute Manual for Evidence Synthesis and PRISMA statement for scoping review. Published reviews on disinvestment were identified from scientific databases including health technology assessment (HTA) Web sites using the terms "disinvestment," "health technology reassessment," and "healthcare." The data obtained was synthesized narratively to identify similarities and differences across the approaches based on the prespecified categories.
Seventeen reviews were included with thirty-four initiatives identified across sixteen countries at various levels of implementation and responsible agencies for the activities. Two most used methods to facilitate disinvestment decisions are Programme Budgeting and Marginal Analysis (PBMA) and HTA. Stakeholder involvement is the most important aspect to be addressed, as it acts as both facilitator and barrier in disinvestment initiatives implementation.
Disinvestment programs have been implemented at multilevel, involving multistakeholders and using multiple methods such as PBMA and HTA. However, there is a lack of clarity on the additional dimensions of technical analysis related to these tools. Further research could focus on technology optimization in healthcare as part of overall health technology management.
全球范围内，对低价值卫生技术的投资削减正在增加。为实施投资削减计划，采用了各种不同的证据收集和评估方法，但不足一半的实证研究报告显示低价值服务的使用有所减少。本范围综述旨在综合现有关于医疗保健投资削减概念和目的、所采用的方法和手段、利益攸关方和促进者的作用以及实施中的障碍的综述信息。
本范围综述遵循循证卫生保健干预措施评价手册和 PRISMA 声明对范围综述的指导。使用“投资削减”、“卫生技术再评估”和“医疗保健”等术语，从包括卫生技术评估（HTA）网站在内的科学数据库中确定关于投资削减的已发表综述。根据预先规定的类别，对获得的数据进行叙述性综合，以确定方法之间的异同。
共纳入 17 篇综述，涉及 16 个国家的 34 项计划，这些计划处于不同的实施阶段，涉及不同的活动负责机构。促进投资削减决策的两种最常用方法是项目预算编制和边际分析（PBMA）和 HTA。利益攸关方的参与是最重要的方面，因为它在投资削减计划的实施中既是促进者，也是障碍。
已在多层次实施了投资削减计划，涉及多利益攸关方，并采用了 PBMA 和 HTA 等多种方法。但是，这些工具的相关技术分析的其他方面缺乏明确性。进一步的研究可以集中在医疗保健中的技术优化上，作为整体卫生技术管理的一部分。
