Identifying ineffective interventions and health technologies: models and their implementation

Research area: HTA-methods & steering instruments

Duration: April 2013 – October 2013
Publication: LBI-HTA Project report No. 68: https://eprints.aihta.at/1014/

Language: German

Background:
Health- care decision-makers are facing the challenge of providing patients’ access to effective, safe, efficient and demand-oriented medical interventions around the world. Therefore, there is an increasing interest in methods and strategies to identify ineffective and inefficient technologies and health services. The goal is to redirect released funds to more effective, high-quality alternatives.

Currently neither a consistent term for existing approaches to identify inefficient, obsolete or needless interventions nor universally applicable frameworks or tools exist. Therefore, initiatives in several countries which develop and implement strategies use quite different approaches: participative strategies like the “Choosing Wisely- Campaign” are accompanied by HTA respectively Health Technology Reassessment and “Program Budgeting and Marginal Analysis”. Differences are, amongst others, the level of stakeholder involvement and their focus of interest: some initiatives are mainly targeted at identifying and avoiding over-diagnosing and ensuing therapies whereas others aim to replace obsolete technologies by better alternatives.

In Austria, ongoing discussion about potential strategies to identify ineffective interventions and health technologies and their implementation is taking place with different stakeholders participating. The potential of adapting and implementing already existing models in Austria has to be analysed yet.

Aims of project:
The aims of this project are to
1) describe applied models for identification of ineffective interventions and technologies, analyse advantages and disadvantages and identify possible barriers for implementation.

2) identify potential areas for application and to describe requirements for implementation within the Austrian health-care system.

Research objectives
1) Methods and strategies to identify ineffective interventions
1.1) Which models for the identification of ineffective interventions/technologies are internationally used in current practice?
1.2) What are the advantages and disadvantages of these models?
1.3) What challenges and barriers are associated with the implementation of these models?

2) Applicability in Austria
2.1) Identification of potential application areas in Austria.
2.2) Description of requirements and necessary adaptations for a successful implementation in Austria.
2.3) Identification of relevant stakeholders that should be involved in the process.

Methods:
- Systematic literature search, additional hand search
- Identification of Good Practice- examples of selected international institutions/initiatives under consideration of existing reviews.
- Interviews with international and national experts

Time schedule/ milestones (in months):
04/2013: Compilation of Study protocol
05/2013 – 10/2013: Literature search, contacting experts, interviews
06/2013 – 10/2013: Report generation
10/2013: Internal (and external) review

References:
Gerdvilaite, J., Nachtnebel, A. Disinvestment: overview of disinvestment experiences and challenges in selected countries. HTA- project report. 2011; No. 57. Vienna: Ludwig Boltzmann Institut for Health Technology Assessment.

Gallego, G. et al. Reducing the use of ineffective health care interventions. Working paper. 2010; No.5. Sydney: University of Technology Sydney: Centre for Health Economics Research and Evaluation.

Choosing Wisely. About the Campaign. 2013. http://www.choosingwisely.org/