The added value of applying a disinvestment approach to the process of health technology assessment in Italy

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Abstract

Objectives

The objective of the present policy analysis was to understand how a disinvestment approach to the process of health technology assessment (HTA), applied to the field of medical devices, might help Italian policymakers to properly spend the resources in healthcare.

Methods

Previous international and national experiences in disinvestment for medical devices were reviewed. Precious insights for the rational expenditure of the resources were derived by assessing the evidence available.

Results

The disinvestment of ineffective or inappropriate technologies or interventions with an inadequate value-for-money ratio has become a growing priority for National Health Systems. Different international disinvestment experiences of medical devices were identified and described through a rapid review. Although most of them have a strong theoretical framework, their practical application remains difficult. In Italy, there are no examples of large and complex HTA-based disinvestment practices, but their importance is becoming increasingly acknowledged, especially given the need to prioritize the funds provided by Recovery and Resilience Plan.

Conclusions

Anchoring decisions on health technologies without reassessing the current technological landscape through a robust HTA model might expose to the risk of not ensuring the best employment of the resources available. Thus, it is necessary to develop a strong HTA ecosystem in Italy through adequate consultation with stakeholders to enable a data-driven and evidence-based prioritization of resources toward choices characterized by high value for both patients and society as a whole.

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Most cited references 16

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The new definition of health technology assessment: A milestone in international collaboration

Brian O'Rourke, Wija Oortwijn, Tara Schuller (2020)

An international joint task group co-led by the International Network of Agencies for Health Technology Assessment (INAHTA) and Health Technology Assessment International (HTAi) has developed a new and internationally accepted definition of HTA. The task group, consisting of representatives of leading HTA networks, societies and global organizations, developed guiding principles for the process and followed an established consultation plan with the broader HTA community to develop the definition. The consensus achieved by the international joint task group brings the collective weight of the participating networks, societies, and organizations behind the new definition. The new definition of HTA is an historic achievement and it is offered to the current and emerging HTA world as a cornerstone reference for today and into the future.

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Trends in Medicare payments in the last year of life.

J D Lubitz, G F Riley (1993)

Increased attention is being paid to the amount and types of medical services rendered in the period before death. There is a popular impression that a greater share of resources is being devoted to dying patients than in the past. We examined trends in the proportion of Medicare expenditures for persons 65 years old or older in their last year of life to determine whether there were any changes from 1976 to 1988. Using Medicare program data for 1976, 1980, 1985, and 1988, we classified Medicare payments according to whether they were made for people in their last year of life (decedents) or for survivors. We also assigned expenses for care in the last year of life according to intervals of 30 days before the person's death and examined trends according to age. Reflecting the large overall increase in Medicare spending, Medicare costs for decedents rose from $3,488 per person-year in 1976 to $13,316 in 1988. However, Medicare payments for decedents as a percentage of the total Medicare budget changed little, fluctuating between 27.2 and 30.6 percent during the study period. Payments for care during the last 60 days of life expressed as a percentage of payments for the last year also held steady at about 52 percent. Furthermore, the pattern of lower payments for older as compared with younger decedents also prevailed throughout the study period. The same forces that have acted to increase overall Medicare expenditures have affected care for both decedents and survivors. There is no evidence that persons in the last year of life account for a larger share of Medicare expenditures than in earlier years.

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Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices

Adam G Elshaug, Janet E Hiller, Sean R. Tunis … (2007)

Background Internationally, many health care interventions were diffused prior to the standard use of assessments of safety, effectiveness and cost-effectiveness. Disinvestment from ineffective or inappropriately applied practices is a growing priority for health care systems for reasons of improved quality of care and sustainability of resource allocation. In this paper we examine key challenges for disinvestment from these interventions and explore potential policy-related avenues to advance a disinvestment agenda. Results We examine five key challenges in the area of policy driven disinvestment: 1) lack of resources to support disinvestment policy mechanisms; 2) lack of reliable administrative mechanisms to identify and prioritise technologies and/or practices with uncertain clinical and cost-effectiveness; 3) political, clinical and social challenges to removing an established technology or practice; 4) lack of published studies with evidence demonstrating that existing technologies/practices provide little or no benefit (highlighting complexity of design) and; 5) inadequate resources to support a research agenda to advance disinvestment methods. Partnerships are required to involve government, professional colleges and relevant stakeholder groups to put disinvestment on the agenda. Such partnerships could foster awareness raising, collaboration and improved health outcome data generation and reporting. Dedicated funds and distinct processes could be established within the Medical Services Advisory Committee and Pharmaceutical Benefits Advisory Committee to, a) identify technologies and practices for which there is relative uncertainty that could be the basis for disinvestment analysis, and b) conduct disinvestment assessments of selected item(s) to address existing practices in an analogous manner to the current focus on new and emerging technology. Finally, dedicated funding and cross-disciplinary collaboration is necessary to build health services and policy research capacity, with a focus on advancing disinvestment research methodologies and decision support tools. Conclusion The potential over-utilisation of less than effective clinical practices and the potential under-utilisation of effective clinical practices not only result in less than optimal care but also fragmented, inefficient and unsustainable resource allocation. Systematic policy approaches to disinvestment will improve equity, efficiency, quality and safety of care, as well as sustainability of resource allocation.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Technol Assess Health Care

Journal ID (iso-abbrev): Int J Technol Assess Health Care

Journal ID (publisher-id): THC

Title: International Journal of Technology Assessment in Health Care

Publisher: Cambridge University Press (New York, USA )

ISSN (Print): 0266-4623

ISSN (Electronic): 1471-6348

Publication date (Electronic, collection): 2023

Publication date (Electronic): 02 March 2023

Volume: 39

Issue: 1

Electronic Location Identifier: e17

Affiliations

[1 ]Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore , Rome, Italy

[2 ]Graduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore , Rome, Italy

Author notes

[* ] Author for correspondence: Chiara Cadeddu, E-mail: chiara.cadeddu@ 123456unicatt.it

Author information

Chiara Cadeddu https://orcid.org/0000-0003-0149-1078

Luca Regazzi https://orcid.org/0000-0002-0189-7687

Eugenio Di Brino https://orcid.org/0000-0001-7964-3348

Article

Publisher Item ID: S0266462323000107

DOI: 10.1017/S0266462323000107

PMC ID: 11570134

PubMed ID: 36861658

SO-VID: 79c40f2b-8e14-43f8-b3e4-27d038f558ae

License:

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

History

Date received : 03 February 2022

Date revision received : 05 December 2022

Date accepted : 05 February 2023

Page count

Figures: 1, Tables: 1, References: 29, Pages: 7

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