A novel research design can aid disinvestment from existing health technologies with uncertain effectiveness, cost-effectiveness, and/or safety

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Abstract

Disinvestment is critical for ensuring the long-term sustainability of health-care services. Key barriers to disinvestment are heterogeneity between research and clinical settings, absence of evidence of effectiveness of some health technologies, and exposure of patients and organizations to risks and poor outcomes. We aimed to develop a feasible research design that can evaluate disinvestment in health technologies of uncertain effectiveness or cost-effectiveness. Study Design and Setting This article (1) establishes the need for disinvestment methodologies, (2) identifies the ethical concerns and feasibility constraints of conventional research designs for this issue, (3) describes the planning, implementation, and analytical framework for a novel disinvestment-specific study design, and (4) describes potential limitations in application of this design. Results The stepped-wedge, roll-in cluster randomized controlled trial can facilitate the disinvestment process, whereas generating evidence to determine whether the decision to disinvest was sound in the clinical environment. A noninferiority research paradigm may be applied to this methodology to demonstrate that the removal of a health technology does not adversely affect outcomes. Conclusion This research design can be applied across multiple fields and will assist determination of whether specific health technologies are clinically effective, cost-effective, and safe.
Original languageEnglish
Pages (from-to)144 - 151
Number of pages8
JournalJournal of Clinical Epidemiology
Volume67
Issue number2
DOIs
Publication statusPublished - 2014

Cite this

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title = "A novel research design can aid disinvestment from existing health technologies with uncertain effectiveness, cost-effectiveness, and/or safety",
abstract = "Disinvestment is critical for ensuring the long-term sustainability of health-care services. Key barriers to disinvestment are heterogeneity between research and clinical settings, absence of evidence of effectiveness of some health technologies, and exposure of patients and organizations to risks and poor outcomes. We aimed to develop a feasible research design that can evaluate disinvestment in health technologies of uncertain effectiveness or cost-effectiveness. Study Design and Setting This article (1) establishes the need for disinvestment methodologies, (2) identifies the ethical concerns and feasibility constraints of conventional research designs for this issue, (3) describes the planning, implementation, and analytical framework for a novel disinvestment-specific study design, and (4) describes potential limitations in application of this design. Results The stepped-wedge, roll-in cluster randomized controlled trial can facilitate the disinvestment process, whereas generating evidence to determine whether the decision to disinvest was sound in the clinical environment. A noninferiority research paradigm may be applied to this methodology to demonstrate that the removal of a health technology does not adversely affect outcomes. Conclusion This research design can be applied across multiple fields and will assist determination of whether specific health technologies are clinically effective, cost-effective, and safe.",
author = "Haines, {Terrence Peter} and O'Brien, {Lisa Jane} and McDermott, {Fiona Margaret} and Donna Markham and Deb Mitchell and Watterson, {Dina Michelle} and Elizabeth Skinner",
year = "2014",
doi = "10.1016/j.jclinepi.2013.08.014",
language = "English",
volume = "67",
pages = "144 -- 151",
journal = "Journal of Clinical Epidemiology",
issn = "0895-4356",
publisher = "Elsevier",
number = "2",

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T1 - A novel research design can aid disinvestment from existing health technologies with uncertain effectiveness, cost-effectiveness, and/or safety

AU - Haines, Terrence Peter

AU - O'Brien, Lisa Jane

AU - McDermott, Fiona Margaret

AU - Markham, Donna

AU - Mitchell, Deb

AU - Watterson, Dina Michelle

AU - Skinner, Elizabeth

PY - 2014

Y1 - 2014

N2 - Disinvestment is critical for ensuring the long-term sustainability of health-care services. Key barriers to disinvestment are heterogeneity between research and clinical settings, absence of evidence of effectiveness of some health technologies, and exposure of patients and organizations to risks and poor outcomes. We aimed to develop a feasible research design that can evaluate disinvestment in health technologies of uncertain effectiveness or cost-effectiveness. Study Design and Setting This article (1) establishes the need for disinvestment methodologies, (2) identifies the ethical concerns and feasibility constraints of conventional research designs for this issue, (3) describes the planning, implementation, and analytical framework for a novel disinvestment-specific study design, and (4) describes potential limitations in application of this design. Results The stepped-wedge, roll-in cluster randomized controlled trial can facilitate the disinvestment process, whereas generating evidence to determine whether the decision to disinvest was sound in the clinical environment. A noninferiority research paradigm may be applied to this methodology to demonstrate that the removal of a health technology does not adversely affect outcomes. Conclusion This research design can be applied across multiple fields and will assist determination of whether specific health technologies are clinically effective, cost-effective, and safe.

AB - Disinvestment is critical for ensuring the long-term sustainability of health-care services. Key barriers to disinvestment are heterogeneity between research and clinical settings, absence of evidence of effectiveness of some health technologies, and exposure of patients and organizations to risks and poor outcomes. We aimed to develop a feasible research design that can evaluate disinvestment in health technologies of uncertain effectiveness or cost-effectiveness. Study Design and Setting This article (1) establishes the need for disinvestment methodologies, (2) identifies the ethical concerns and feasibility constraints of conventional research designs for this issue, (3) describes the planning, implementation, and analytical framework for a novel disinvestment-specific study design, and (4) describes potential limitations in application of this design. Results The stepped-wedge, roll-in cluster randomized controlled trial can facilitate the disinvestment process, whereas generating evidence to determine whether the decision to disinvest was sound in the clinical environment. A noninferiority research paradigm may be applied to this methodology to demonstrate that the removal of a health technology does not adversely affect outcomes. Conclusion This research design can be applied across multiple fields and will assist determination of whether specific health technologies are clinically effective, cost-effective, and safe.

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U2 - 10.1016/j.jclinepi.2013.08.014

DO - 10.1016/j.jclinepi.2013.08.014

M3 - Article

VL - 67

SP - 144

EP - 151

JO - Journal of Clinical Epidemiology

JF - Journal of Clinical Epidemiology

SN - 0895-4356

IS - 2

ER -