[:pb]The incorporation of technologies is a complex process that generally involves high costs for healthcare systems, whether public or private. Not to mention the responsibility for the lives of the population, a fundamental factor for all decision-making in this regard. Therefore, the incorporated technologies need to be eventually re-evaluated and, if this new analysis shows that the drug, equipment, product or service did not reach the expected goals and no longer present health benefits compatible with the expenses spent, it is possible to opt for disinvestment.

From this decision, it is necessary to reinvest the financial resources applied in the technology used until then. This reinvestment, however, does not necessarily consist in allocating values in a technology that directly replaces the one that was eliminated or restricted, but it can be directed to another area of the health system. The objective of a divestment in a technology, therefore, is to maximize health gains with the available financial resources.. Learn more about the topic.

Healthcare Technology Performance Assessment (HpTA)

The disinvestment and reinvestment processes have as instrument the Healthcare Technology Performance Assessments (HpTA). Basically, they are the analyzes that the technology goes through after it has already been incorporated. While Healthcare Technology Assessments (HTA), carried out to recommend or not incorporation, are based on clinical and economic studies, HpTA use information from the real world, known as RWE (real world evidence). Among them are data on effectiveness, safety, logistics and acceptance of the healthcare system in practice.

Disinvestment and reinvestment modalities in healthcare technologies

The healthcare technologies that undergo this type of reassessment are those that have become obsolete over time, that have some security flaw or that show signs of not being so interesting from the point of view of cost-effectiveness. If these problems are confirmed with the realization of HpTA, the technology may no longer be financed as it was until then, so that the resources spent on it are applied to other technologies, which bring greater benefit to the population and greater return on investment. But that doesn’t necessarily mean abandoning the technology altogether. Disinvestment can take place in the following modalities:

• Disincorporation: removal of technology from the healthcare system completely;
• Restriction: the use of technology is restricted to specific groups or subgroups of patients, with which it is more effective;
• Retraction: technology is now offered less frequently or in lesser quantity, so that it does not harm health outcomes. An example is the increase in the waiting period between one exam and another;
• Replacement: complete removal of current technology to incorporate a new product or service that offers a better or equivalent health result, but with better cost-effectiveness.

It is also possible to remove the technology for a certain time, only in a specific healthcare service, to assess in practice what the impacts of disinvestment are.

Stages of the disinvestment and reinvestment process

The disinvestment and reinvestment process can be even more complex than that of incorporating technologies, but it basically follows the same steps:

• Emergence of demand, which may come from the healthcare system itself or from social needs;
• Assessment of the need for divestment;
• Technology reassessment through a Healthcare Technology Performance Assessment (HpTA);
• If the assessment indicates the need for disinvestment, it is time to analyze which modality is most suitable. The disincorporation of a technology should not be the main focus, as, in addition to being few candidates for this modality, it can be very unpopular, especially if it is a product or service that is well accepted by society;
• Production of a report with the recommendation or not of disinvestment, which must be submitted to the main manager of the health system, for final decision. The document should indicate alternatives and describe possible scenarios, such as maintaining the technology and different types of feasible disinvestment;
• If the option is for disinvestment, the process is carried out according to the necessary criteria for each technology.

To learn more about our solutions for incorporating healthcare technologies, download the MAPES e-book: MAPES: Cases &Soluções.[:]