OBJECTIVES: This research aims to systematically review the impact, processes, policies and experiences of disinvestment that have been reported and implemented worldwide over the last 10 years.

METHODS: A systematic literature research was carried out, without language restrictions for articles published from January 2010 to May 2022. The following databases were considered: MEDLINE, EMBASE, LILACS, The Cochrane Library, Ecolint CINAHL and Global Health. We also searched HTA agencies' websites (INHATA, RedETSA) and Google.

RESULTS: A total of 3370 articles were screened and finally, 39 articles met eligibility criteria. The studies reported: methodology only (N=23), experiences with formal measurement of outcomes (N=14), experiences without formal measurement of outcomes (N=13), policies (N=5). Most of the studies were conducted in developed countries,and only five studies were conducted in low- and middle-income countries (LMICs) (two in Brazil, and one each in Argentina, Singapore and Romania). Most cases presented a national perspective. Regarding the methodologies, most studies (52%) proposed new frameworks and Programme Budgeting and Marginal Analysis (PBMA), and all used evidence-based identification and prioritization of technologies. Considering experiences with formal measurement of outcomes, all five studies evaluating economic outcomes found cost savings. The remaining studies showed reductions in disinvested technologies’ use. In those related to experiences without formal measurement of outcomes, reports qualitatively described their implementation experiences, between 2006 and 2017. The policies implemented were at the national level, between 2009 and 2014.

CONCLUSIONS: We found no health impact evaluation of disinvestment and only few assessed the economic impact. A large amount of methodologies were reported. However, scarce implementation experiences were found, particularly in LMICs. Disinvestment methodologies provide transparency in decision-making processes, but policies and political commitment are still critical to fully implement disinvestment initiatives.