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Table 2 Examples of theoretical reasons for disinvestment

From: Sustainability in Health care by Allocating Resources Effectively (SHARE) 2: identifying opportunities for disinvestment in a local healthcare setting

Reasons for disinvestment Considerations
Unsafe or harmful (Absolute) ▪ Definitions or operational criteria not provided
▪ Emergency/major safety problems are already addressed through alerts and recalls, no definition or criteria for lower-level safety issues
Less safe (Relative) ▪ Higher rate of the same adverse events
▪ Other adverse events which are thought to be worse (but no guidance/criteria for comparison)
Clinically ineffective (Absolute) ▪ No or very low health gain
▪ No medical indication eg cosmetic procedure
Less clinically effective (Relative) ▪ Lower rate of the same positive outcomes
▪ Other positive outcomes thought to be less desirable (but no guidance/criteria for comparison)
Cost ineffective (Absolute) ▪ Considers effectiveness and cost
▪ Requires threshold, no definition or criteria provided
Less cost-effective (Relative) ▪ Provides less health gain for their cost than alternative
▪ No definition or criteria provided
Outdated, superseded, obsolete ▪ Inferior to more recently introduced TCPs
▪ No definition or criteria provided
External factors Political decisions, local priorities, rationalisation, organisational capacity and capability