Disinvestment in cancer care: a survey investigating European countries' opinions and views

• Published in: European journal of public health 2018-12, Vol.28 (6), p.987-992
• Main Authors: Specchia, Maria Lucia, La Torre, Giuseppe, Calabrò, Giovanna Elisa, Villari, Paolo, Grilli, Roberto, Federici, Antonio, Ricciardi, Walter, de Waure, Chiara
• Format: Article
• Language: English
• Subjects: Cancer; Diagnostic systems; Expenditures; Health care; Health care expenditures; Oncology; Policies; Polls & surveys; Public health; Questionnaires; Technology assessment
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/cky033

The current economic context calls for rationalizing health resources that can be pursued through disinvestment from low value health technologies to invest in the best performing ones, ensuring high healthcare quality. Oncology is a field where, because of high costs of health technologies and rapid innovation, disinvestment is crucial. On this basis, the research team investigated through a survey, based on a questionnaire, opinions and views of representatives of European countries about disinvestment, in terms of fields of application, potential advocates and barriers, specifically focusing on cancer care. A total of 17 questionnaires were filled in (response rate: 32.1%). The survey showed disinvestment is applied in several countries as a tool for containing health care expenditures and identifying obsolete technologies/ineffective interventions. Clinicians' resistance to change and industries' opposition are recognized as the most important barriers to the implementation of disinvestment policies. Potential targets of disinvestment in cancer are seen in diagnostic and therapeutic areas. Despite the agreement on fields of waste and of disinvestment policies, operational methods to put disinvestment in place are lacking. Since they should rely on an inclusive assessment of the technology, Health Technology Assessment may represent a good approach.