DRUG DISINVESTMENT FRAMEWORKS: COMPONENTS, CHALLENGES, AND SOLUTIONS.

Area of Science:

• Health Technology Assessment
• Pharmaceutical Policy
• Health Economics

Background:

• Value assessments are crucial for marketed drug technologies, often utilizing disinvestment frameworks.
• Existing disinvestment frameworks exhibit diverse components and face significant implementation hurdles.

Purpose of the Study:

• To systematically review and describe the process components of drug disinvestment frameworks.
• To report on the identified framework components, associated challenges, and potential solutions.

Main Methods:

• A comprehensive systematic literature search was performed across major databases (MEDLINE, EMBASE, PubMed, Cochrane Library, CINAHL) from 2000 to 2015.
• Gray literature searches of Health Technology Assessment international (HTAi) and International Network of Agencies for Health Technology Assessment (INAHTA) were also conducted.

Main Results:

• Forty articles were included in the qualitative analysis, revealing varied framework components like definitions, criteria, assessment processes, stakeholders, and dissemination strategies.
• A significant finding is the lack of political, administrative, and clinical will among stakeholders to support disinvestment, with no single framework recognized as best practice.

Conclusions:

• Drug technology disinvestment processes are inconsistent and fraught with challenges.
• Future research should address value assessment challenges by promoting neutral terminology, fixed reassessment timelines, therapeutic reviews, and refined decision-making frameworks.