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From investment to disinvestment

Plennary sessionHTAi 2012, BilbaoJune 25th

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Technologies of no added-value…

"I've seen things you people wouldn't believe. Attack ships on fire off the shoulder of Orion. I watched C-beams glitter in the dark near the Tannhauser gate. All those moments will be lost in time... like tears in rain... Time to die.”

Blade runner

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Technologies are “ever-changing”

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Some technologies still in useSome technologies still in use

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Sometimes it is related to the technology

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Sometimes to lack of skillsSometimes to lack of skills

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Decision-making process

• It is difficult to say yes but…

• It is even more difficult to say no…

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It is difficult to say yes…

• This systematic review has clearly identified the need for randomised or controlled clinical trials assessing the effectiveness of … to support the decision on investment.

• The researchers said there was a lack of direct evidence that the treatment work for…

• Further research is needed on the use of the technology in this subgroup of population to extent its use…

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It is even more difficult to say no,…

• The use of glucosamine or chondroitin products is not recommended for the treatment of osteoarthritis.

• There is some evidence to suggest that chondroitin sulphate is of no benefit in treating OA of the knee. GPs could inform patients about the lack of evidence of benefit over placebo.

But,…• We conditionally recommend that patients with

knee OA should not use the following: glucosamine or chondroitin…

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In fact,…

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Keep the Door Opened

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Room for improvement

• Cost containment is not the solution.

• “The savings potentially achievable from systematic, comprehensive, and cooperative pursuit of even a fractional reduction in waste are far higher than from more direct and blunter cuts in care and coverage”

• 20%

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The subject

• Four different perspectives:

– Methods and experiences to perform disinvestment

– Stakeholders involvement– Role of HTA in disinvestment processes in

hospitals– Conclusions of the Policy Forum

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