Objectives: Disinvestment of existing healthcare technologies that deliver low or no health benefit for their cost can be used as a tool to improve access to effective technologies, while ensuring the long-term sustainability of healthcare systems. The objective of this research was to identify disinvestment initiatives in Latin American countries (LAC).

Methods: First, a systematic literature review (SLR) was conducted. In February 2015, MEDLINE, MEDLINE In-Process, EMBASE, The Cochrane Library, and LILACS were searched for relevant journal articles, including terms related to “disinvestment,” “reallocation,” “obsolete technologies,” and “Latin America.” Additionally, a manual search of documents from Latin American health technology assessment agencies was performed. Second, an online questionnaire was sent to experts in LAC to assess whether unpublished real-life disinvestment initiatives exist. Questionnaire results were collected in September 2015.

Results: From the SLR, 350 records were selected for screening following de-duplication and eleven articles fulfilled inclusion criteria. Only two of these reported information on initiatives potentially identifiable as disinvestment-investment activities in Brazil and Peru. Nine respondents completed the questionnaire, and four reported that disinvestment initiatives had been conducted in their respective organizations in Argentina, Brazil, and Mexico. This lack of agreement between the SLR and the questionnaire responses shows that disinvestment initiatives are ongoing, despite being under reported.

Conclusions: Many challenges need to be overcome for a disinvestment initiative to be successful, and sharing particular experiences with the international community would increase the chances of positive outcomes. The present study highlights the need for publication of such experiences in LAC.

Background: Non small cell lung cancer (NSCLC) diagnosis and treatment is a highly complex process, requiring managerial skills merged with clinical knowledge and experience. Integrated care pathways (ICPs) might be a good strategy to overview and improve patient's management. The aim of this study was to review the ICPs of NSCLC patients in a University Hospital and to identify areas of quality improvement.

Materials and Methods: The electronic medical records of 169 NSCLC patients visited at the University Hospital were retrospectively reviewed. Quality of care (QoC) has been measured trough fifteen indicators, selected according main international Guidelines and approved by the multi-disciplinary team for thoracic malignancies. Results have been compared with those of a similar retrospective study conducted at the same hospital in 2008.

Results: A total of 146 patients were considered eligible. Eight of fifteen indicators were not in line with the benchmarks. We compared the results obtained in the two separate periods. Moreover, we process some proposal to be discussed with the general management of the hospital, aimed to redesign NSCLC care pathways.

Conclusions: ICPs confirm to be feasible and to be an effective tool in real life. The periodic measurement of QoC indicators is necessary to ensure clinical governance of patients pathways.

The Monitoring Studies (MS) program, the approach developed by RedETS to generate postlaunch real-world evidence (RWE), is intended to complement and enhance the conventional health technology assessment process to support health policy decision making in Spain, besides informing other interested stakeholders, including clinicians and patients. The MS program is focused on specific uncertainties about the real effect, safety, costs, and routine use of new and insufficiently assessed relevant medical devices carefully selected to ensure the value of the additional research needed, by means of structured, controlled, participative, and transparent procedures. However, despite a clear political commitment and economic support from national and regional health authorities, several difficulties were identified along the development and implementation of the first wave of MS, delaying its execution and final reporting. Resolution of these difficulties at the regional and national levels and a greater collaborative impulse in the European Union, given the availability of an appropriate methodological framework already provided by EUnetHTA, might provide a faster and more efficient comparative RWE of improved quality and reliability at the national and international levels.

The models and analyses used in this study represent an important step in the continued search for the optimum use of surgery for the treatment of lower back pain. The likelihood of patients who are hospitalized with lower back pain in Massachusetts receiving either laminectomies or spinal fusions or both was increased when any of the following demographic, socioeconomic, or medical characteristics were present: white, male, well insured, young, routine admission, admitted to a medium-sized hospital, admitted to a teaching hospital, admitted to a hospital with a high occupancy rate, and discharged home.

Respiratory insufficiency has previously been a frequent cause of neonatal death, especially in preterm infants. As late as in 1967, Silverman and associates (66) found that in infants with hyaline membrane disease (HMD), mechanical ventilation with a body-enclosing negative pressure respirator did not improve survival. Before 1970, the mortality among infants who required respiratory therapy was high (20;46;70). At the end of the 1960s and the beginning of the 1970s, several new methods were introduced to improve ventilation of newborn infants. Kirby and coworkers (41) introduced intermittent mandatory ventilation as a way of weaning from mechanical ventilation. In a series of studies, Reynolds and coworkers evaluated the effects of different peak airway pressures, respiratory frequencies, and inspiratory:expiratory ratios on arterial blood gases and right to left shunts (32;58;59;60).

Mental health services depend both on efficacious drug and interpersonal interventions and strategies for financing, organizing, and delivering these services. In recent years, much attention has been devoted to approaches that seek to coordinate needed care and to provide it in the most cost-effective ways. Cost constraints encourage the substitution of alternative community treatments for expensive inpatient care and the identification of appropriate ways to link effectively the varying care components. The mechanism most commonly advocated is case management, but the concept is applied in diverse ways and has little agreed upon meaning and disparate outcomes. This paper discusses and evaluates concepts of case management and a variety of other systems interventions designed to reduce fragmentation. It also reviews approaches to managed care, including mental health capitation and utilization management. New organizational technologies are likely to change dramatically professional practices and standards and the future provision of mental health care.

Acquiring expensive, new medical technology requires an evaluation of the efficacy and effectiveness, safety, profitability, feasibility, and risk of a project in the context of the hospital's social responsibility and institutional strategy. A case study of the decision to bring biliary lithotripsy to Strong Memorial Hospital illustrates how these criteria offer managers a coherent approach to difficult and consequential decisions about acquiring medical technology.

Prior to the nationwide diffusion of a new technology, evidence must be assembled to demonstrate that a new technology is, in the terminology of WHO, appropriate. Not everything that is new in health technology is good; not all that is good is needed. It is by no means unethical to demand adequate assessment of new technology before it is diffused. On the contrary, it is unethical to squander resources on hazardous and uneffective treatment. Of the methods available for assessment, the randomized clinical trial is among the most valuable. Randomized clinical trials cannot, however, solve all problems. Speed is a critical element. It is not ethical to permit excessive delay. Balanced, relevant, and informative studies must be conducted as quickly as possible and with a maximum of international collaboration. WHO has a valuable role to play in advising on, coordinating, supporting, and disseminating the findings of such studies.

The purpose of this paper is to outline some of the key methodologic issues in designing clinical trials to assess the cost-effectiveness of clinical magnetic resonance imaging (MRI). Because the possible objectives of such trials are so diverse, and the appropriate methodologies correspondingly numerous, no attempt is made to identify a single objective or methodology as appropriate. Rather, this paper should be read as an “options paper,” in which alternative formulations of objectives, outcome measures, study design, and protocol instrumentation are reviewed, with critical discussion of their theoretical strengths and weaknesses, as well as their practical implementability.

Some studies suggest that breast-conserving treatment increases the cost of breast cancer. Estimates from a social perspective show that incremental cost depends on the proportion of lumpectomies done in outpatient facilities and on the demand for reconstructive surgery. Conservative treatment reduces spending within a reasonable range of values.

This article describes and explains the impact of the National Health Service bureaucracy on the diffusion of medical technology in the United Kingdom. Through case studies of six medical technologies, the author demonstrates how health care authorities may exercise significant control by using the central financing system to dampen the general diffusion of technology. However, the United Kingdom has less control in specific cases due to the absence of a bureaucratic body to coordinate the evaluation and introduction of new technology.

The treatment of End-Stage Renal Disease (ESRD) is one of the most widely debated topics in contemporary medicine. The high cost of the most usual treatment, hemodialysis, has been and still is the topic for numerous discussions concerning priorities in health care on the one hand, and various medical, psychological, and ethical problems of life “on the machine” on the other hand. The other treatment of ESRD, kidney transplantation, raises other, no less complicated questions such as the limits of medical experimentation, ownership of one's body, the donation of organs, organ procurement and allocation, and the definition of life and death. As Fox and Swazey put it “The importance of hemodialysis and human organ transplantation lies as much in their social and cultural significance as in their medical and surgical value” (27,376).

Canada comprises 10 provinces and 2 territories. The Constitution assigns responsibility for the provision of health services in the provinces to provincial governments. Over the past 5 years, provincial governments have identified technology assessment as a priority. This paper describes an initiative taken by the government of the province of Alberta to develop a health technology assessment program for that province.

The rising costs of health care and interest in the evaluation of health services and systems have sparked an increased need for technology assessment. A variety of available methods of assessment are described in the Institute of Medicine's book Assessing Medical Technologies (1). Although such methods as the randomized controlled trial (RCT) are widely accepted and used, obtaining information by such methods often takes a considerable amount of time, expense, and sophistication in study design. These costs suggest that a broader range of methods for collecting information about health care technologies should be considered. A vast resource of data collected on patients, ranging from a provider's practice records to national data sets, might be useful for technology assessment if it could be properly appraised.

This paper indicates that certain economic evaluation methods (cost-effectiveness and cost-utility analyses) may yield inconsistent results. Along with the lack of formal grounding of these methods in economic “first principles,” this finding suggests the possible benefit of greater reliance on the more formally developed method of cost-benefit analysis.

We compared patient ratings of the desirability of anxiety health states with measures of psychological distress and functional status and investigated how these ratings predicted treatment by primary care and mental health clinicians. As expected, associations between desirability ratings and psychological and physical health status were low to moderate. Persons who rated their current anxiety health state as more desirable received fewer mental health referrals and were statistically more likely to receive a prescription for psychotropic medication. Simple ratings of health state desirability may help clinicians evaluate patients' views of their health status and discuss potential treatment options.