This document discusses disinvestment from technologies and summarizes perspectives on the challenging process. It notes that while it is difficult to say yes to new investments, it is even more difficult to say no to existing technologies and withdraw support. The document outlines methods for performing disinvestment, the importance of stakeholder involvement, the role of health technology assessment in hospital disinvestment processes, and conclusions from a policy forum on the subject.

1. From investment
to disinvestment
Plennary session
HTAi 2012, Bilbao
June 25th
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2. 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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3. Technologies are “ever-changing”
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4. Some technologies still in use
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5. Sometimes it is related to the technology
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6. Sometimes to lack of skills
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7. Decision-making process
• It is difficult to say yes
but…
• It is even more
difficult to say no…
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8. 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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9. 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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10. In fact,…
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Standardized DHD
DHD estandarizadas
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4
2
araba bilbao ezkerraldea ekialde mendebalde interior uribe
Primary Care settings
COMARCAS
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11. Keep the Door Opened
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12. 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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13. 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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