title: DISINVESTING FROM INEFFECTIVE TECHNOLOGIES: LESSONS LEARNED FROM CURRENT PROGRAMS.
abstract: OBJECTIVE
  Many of the currently used health technologies have never been systematically assessed or are misused, overused or superseded. Therefore, they may be ineffective. Active identification of ineffectiveness in health care is gaining importance to facilitate best care for patients and optimal use of limited resources. The present research analyzed processes and experiences of programs for identifying ineffective health technologies. The goal of this study was to elucidate factors that facilitate implementation.
  
  
  METHODS
  Based on an overview article, a systematic literature search and unsystematic hand-search were conducted. Further information was gained from international experts.
  
  
  RESULTS
  Seven programs were identified that include identification, prioritization and assessment of ineffective health technologies and dissemination of recommendations. The programs are quite similar regarding their goals, target groups and criteria for identification and prioritization. Outputs, mainly HTA reports or lists, are mostly disseminated by means of the internet. Top-down and bottom-up programs both have benefits in terms of implementation of recommendations, either as binding guidelines and decisions or as nonbinding information for physicians and other stakeholders. Crucial facilitators of implementation are political will, transparent processes and broad stakeholder involvement focusing on physicians.
  
  
  CONCLUSIONS
  All programs can improve the quality of health care and enable cost reduction in supportive surrounding conditions. Physicians and patients must be continuously involved in the process of evaluating health technologies. Additionally, decision makers must support programs and translate recommendations into concrete actions.
authors.affiliation: Ludwig Boltzmann Institute for Health Technology Assessment,Austriajulia.mayer@hta.lbg.ac.at.
authors.forename: Julia
authors.initials: J
authors.lastname: Mayer
authors.affiliation: Ludwig Boltzmann Institute for Health Technology Assessment,Austria.
authors.forename: Anna
authors.initials: A
authors.lastname: Nachtnebel
mesh_terms: D020811:Biomedical Technology; D003363:Cost Control; D003362:Cost-Benefit Analysis; D003657:Decision Making; D017598:Efficiency, Organizational; D006801:Humans; D016134:Organizational Policy; D058996:Quality Improvement; D013673:Technology Assessment, Biomedical
keywords: Disinvestment; Health technology reassessment; Ineffective technologies; Obsolescence; Resource allocation