Article type
Year
Abstract
Background:
Disinvestment is the partial/complete withdrawal of resources from existing health care interventions that have questionable benefit. Different processes have been developed to identify these interventions, however there is not consensus on which one to use. In 2013, the Italian Ministry of Health established a working group in order to evaluate the actual use of the economic resources in oncology and identify potential areas in which it would be appropriate to start a process of disinvestment. The working group was asked to give an answer in six months.
Objectives:
To develop a simple, transparent, evidence-based process allowing the identification of a list of health interventions that have questionable benefit.
Methods:
The project’s steps were:
1. involvement of a regional oncologic commission composed of 30 members who were asked to provide a list of potentially dismissible interventions (PDIs);
2. bibliographic research to find evidence regarding the identified interventions – firstly Cochrane Systematic reviews (SRs), secondly non-Cochrane SRs, and thirdly guidelines indexed in PubMed were searched to support the decision;
3. involvement of a group of representatives of clinicians, policy makers and health economists to reach an agreement, through the Delphi technique, on PDIs.
Results:
The commission identified 37 PDIs (settings: 11 breast cancer; 5 colorectal cancer; 5 lung cancer; 5 prostate cancer; 11 other). Cochrane SRs covered 11/37 clinical questions, non-Cochrane SRs 4/37, guidelines 4/37; for 18/37 no evidence was found, and these were not considered in the following step. The representatives reached a consensus on the 19 interventions; on 18 of them there was agreement on their questionable effect, while for one there was still too much uncertainty.
Conclusions:
The process developed in this study allows a rapid identification of lists of health interventions that are used in clinical practice, but for which the efficacy has not been proven.
Disinvestment is the partial/complete withdrawal of resources from existing health care interventions that have questionable benefit. Different processes have been developed to identify these interventions, however there is not consensus on which one to use. In 2013, the Italian Ministry of Health established a working group in order to evaluate the actual use of the economic resources in oncology and identify potential areas in which it would be appropriate to start a process of disinvestment. The working group was asked to give an answer in six months.
Objectives:
To develop a simple, transparent, evidence-based process allowing the identification of a list of health interventions that have questionable benefit.
Methods:
The project’s steps were:
1. involvement of a regional oncologic commission composed of 30 members who were asked to provide a list of potentially dismissible interventions (PDIs);
2. bibliographic research to find evidence regarding the identified interventions – firstly Cochrane Systematic reviews (SRs), secondly non-Cochrane SRs, and thirdly guidelines indexed in PubMed were searched to support the decision;
3. involvement of a group of representatives of clinicians, policy makers and health economists to reach an agreement, through the Delphi technique, on PDIs.
Results:
The commission identified 37 PDIs (settings: 11 breast cancer; 5 colorectal cancer; 5 lung cancer; 5 prostate cancer; 11 other). Cochrane SRs covered 11/37 clinical questions, non-Cochrane SRs 4/37, guidelines 4/37; for 18/37 no evidence was found, and these were not considered in the following step. The representatives reached a consensus on the 19 interventions; on 18 of them there was agreement on their questionable effect, while for one there was still too much uncertainty.
Conclusions:
The process developed in this study allows a rapid identification of lists of health interventions that are used in clinical practice, but for which the efficacy has not been proven.