Article type
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Abstract
Background: All healthcare systems face increasing pressure to control expenditure without compromising quality or patient safety. Disinvestment in clinically- or cost-ineffective interventions is thought to be key to transferring resources to higher-value care.
Objectives: NICE and the UKCC undertook a pilot project using Cochrane reviews as an evidence base to identify low-value interventions for local NHS disinvestment.
Methods: Over six months all Cochrane reviews concluding that an intervention could not be recommended or should be used only in research were identified by UKCC and evaluated by NICE. (Figure 1). The potential impact of stopping the intervention was assessed against four domains: quality of care, patientcarer experience, patient safety and productivity savings. (Table 1). Interventions were excluded if they: were not relevant to UK practice; required additional investigation; or were unlikely to achieve gains in any domains. Evaluated topics were published as reports suggesting disinvestment opportunities for local healthcare providers. (Table 2)
Results: Of the 65 reviews appraised, 43% provided candidate interventions for local disinvestment. (Table 3) Quantification of potential productivity savings was difficult due to the absence of NHS usage data. Most could not be quantified; one suggested potential savings of £2 million. Many reviews required additional analyses by NICE. Furthermore, many interventions were no longer used or had insufficient evidence to refute potential benefits, making disinvestment recommendations either irrelevant or inappropriate.
Conclusions: This is the first large-scale systematic application of a gold standard evidence base to the problem of disinvestment. It challenges assumptions that disinvestment can produce large savings, highlights the importance of robust processes to evaluate interventions when research evidence is inadequate, and demonstrates the need for detailed data on healthcare usage and expenditure. It identifies a translational gap between the requirements of decision makers and the content of Cochrane reviews, highlighting a need to improve the consistency and precision of Cochrane review conclusions.
Objectives: NICE and the UKCC undertook a pilot project using Cochrane reviews as an evidence base to identify low-value interventions for local NHS disinvestment.
Methods: Over six months all Cochrane reviews concluding that an intervention could not be recommended or should be used only in research were identified by UKCC and evaluated by NICE. (Figure 1). The potential impact of stopping the intervention was assessed against four domains: quality of care, patientcarer experience, patient safety and productivity savings. (Table 1). Interventions were excluded if they: were not relevant to UK practice; required additional investigation; or were unlikely to achieve gains in any domains. Evaluated topics were published as reports suggesting disinvestment opportunities for local healthcare providers. (Table 2)
Results: Of the 65 reviews appraised, 43% provided candidate interventions for local disinvestment. (Table 3) Quantification of potential productivity savings was difficult due to the absence of NHS usage data. Most could not be quantified; one suggested potential savings of £2 million. Many reviews required additional analyses by NICE. Furthermore, many interventions were no longer used or had insufficient evidence to refute potential benefits, making disinvestment recommendations either irrelevant or inappropriate.
Conclusions: This is the first large-scale systematic application of a gold standard evidence base to the problem of disinvestment. It challenges assumptions that disinvestment can produce large savings, highlights the importance of robust processes to evaluate interventions when research evidence is inadequate, and demonstrates the need for detailed data on healthcare usage and expenditure. It identifies a translational gap between the requirements of decision makers and the content of Cochrane reviews, highlighting a need to improve the consistency and precision of Cochrane review conclusions.
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