Health technology reassessment and disinvestment instruments: a scoping review

Evidence on safety, clinical and cost-effectiveness forms a key part of Health Technology Assessment (HTA) value appraisal for new health technologies and is often used to inform reimbursement and market access decisions. However, value may depreciate over the lifecycle of technologies, requiring reassessment to inform disinvestment decisions. This scoping review aimed to synthesise the evidence on tools that address Health Technology Reassessment (HTR) and disinvestment decision-making processes, with a view to identifying the key elements of an appropriate HTR and disinvestment model.

The scoping review was guided by the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Using the keywords "tool" "disinvestment" and "health technology reassessment", studies published in the English language were identified from the following databases: EMBASE, Medline, CINAHL, Web of Science Core Collections, and Google Scholar. Additional sources of unpublished studies and grey literature included websites and databases of Health Technology Assessment International (HTAi), International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and members of the International Network of Agencies for Health Technology Assessment (INAHTA). The studies were screened, and the data extracted from the included studies were mapped to our predefined conceptual framework and synthesised narratively.

Nineteen studies conducted in nine different countries were included in the scoping review. Most of the studies were conducted in high-income countries with formal HTA processes and nine studies conducted in or by researchers in Canada. The studies proposed different frameworks to guide the HTR and disinvestment process, only four of which have been validated in a real-world setting. There was generally underreporting of the sustainability component in proposed models as only three studies considered sustainability.

This scoping review synthesised available evidence on HTR and mapped the attributes of tools in the included studies to our predefined conceptual framework. Our results suggest that a stronger focus on sustainability and a consistent stakeholder engagement process may improve implementation of disinvestment frameworks and tools. Further work on contextualising models to the local setting and beyond HTA-related processes would be required.