Plain Language Summary

What is it about?

Healthcare systems worldwide face significant financial sustainability challenges due to demographic transitions, technological changes, and growing societal expectations, all within a context of limited public resources. Health technology assessment agencies typically regulate the entry of new technologies into publicly funded benefit packages through ex-ante evaluations. However, disinvestment—the reduction or elimination of funding for health technologies that provide little or no health benefit—is rarely done systematically in low- and middle-income countries, despite being a key tool for improving spending efficiency. This study addresses the lack of systematic disinvestment strategies by quantifying both the financial impact and health opportunity costs of disinvesting in 6 candidate health technologies in Colombia that were identified by previous research as potentially wasteful.

How was the research conducted?

The researchers employed a microcosting approach involving 4 sequential steps to measure the impact of disinvestment. First, they identified and collected necessary data from a Colombian health insurer and public databases, including service provision information, associated diagnoses, and sociodemographic data. Next, they defined baseline cases for evaluation using standardized coding systems for medical procedures and drugs in Colombia. The researchers then estimated waste levels for each prioritized technology along with potential financial savings from disinvestment by analyzing patterns of inappropriate use. Finally, they quantified the opportunity cost of reallocating these resources to selected cost-effective alternatives using 3 different methodologies: cost-effectiveness thresholds, closing coverage gaps in prenatal care and human papillomavirus (HPV) vaccination, and estimating health gains from increased coverage of cervical cancer screening and type 2 diabetes management.

What were the results?

The study found significant levels of waste across the 6 analyzed technologies, with computed tomography scans for headaches showing the highest waste level at 24.22% of all such scans, representing potential savings of approximately $9.6 million dollars annually. Cesarean deliveries without relevant medical indications ranked second with 21.62% waste, equivalent to $1.4 million dollars in potential savings. The researchers demonstrated that if resources from CT scans alone were reallocated, they could enable over 9000 additional women to receive prenatal care visits, reducing the existing coverage gap by approximately 6.4%. Similarly, these freed resources could provide complete HPV vaccination schedules to more than 102,000 children or generate 1672 additional quality-adjusted life years through reinvestment in other health interventions. Other technologies showed similar patterns of waste and potential health gains if resources were reallocated to more effective interventions.

Why are the results important?

These findings have significant implications for healthcare systems in Latin America and the Caribbean that face mounting financial pressures. Strategic disinvestment represents a practical pathway to rationalize spending while simultaneously improving health outcomes in the region. By identifying and quantifying waste in specific technologies, health systems can make informed decisions about resource allocation that enhance both efficiency and equity. The study demonstrates that disinvestment is not merely about cutting costs but about better spending—redirecting resources from wasteful or ineffective technologies to highly cost-effective interventions that can narrow coverage gaps and improve population health outcomes. This approach is particularly valuable in resource-constrained settings where maximizing the health impact of limited budgets is essential.

What are the strengths and weaknesses of this study?

A major strength of this study is its pioneering approach to quantifying the opportunity cost of disinvestment in a Latin American context using multiple methodologies, providing a comprehensive assessment of potential health benefits from resource reallocation. The research also offers a practical framework that health authorities can adapt to identify and prioritize technologies for disinvestment based on evidence of waste and potential impact. However, the study has several limitations, including potential underreporting in national health databases and reliance on data from a single health insurer, which may not be representative of the entire Colombian healthcare system. Additionally, the analysis focused only on direct costs and did not account for complications or adverse effects associated with the evaluated technologies, potentially underestimating the true benefits of disinvestment. Future research should expand to include more technologies, explore behavioral and institutional drivers of waste, and evaluate real-world disinvestment programs to provide evidence on feasibility and outcomes.

Note: This content was created with assistance from artificial intelligence (AI) and has been reviewed and edited by ISPOR staff. For more information or for inquiries on ISPOR’s AI policy, click here or contact us at info@ispor.org.