This guide seeks to serve as orientation for the different aspects of obsolete health technology assessment and, in turn, to reflect what, according to the literature and the working group's recommendations or opinions, should be done to ensure proper detection, prioritisation and assessment of potentially obsolete technologies. The guide is based on the following definition of obsolete health technology, agreed upon by a working group made up of Spanish technical staff engaged in health technology assessment:
Obsolete health technology: any health technology in use for one or more indications, whose clinical benefit, safety or cost-effectiveness has been significantly superseded by other available alternatives.
According to this definition, for a technology to be deemed obsolete there must be an alternative that improves its overall outcome. By way of exception, however, a technology will also be deemed obsolete in a case where the alternative is no intervention whatsoever, and this latter course would prove beneficial for the patient.
Moreover, under the definition, an obsolete technology is, in principle, necessarily deemed to be obsolete for a specific indication, and so when assessments are made the technology must be cited along with the indication in question. Occasionally, there may be technologies that are obsolete per se for all indications (e.g., oncological treatments with radiotherapy devices which emit excess dosages and are upgraded).
It is also important to stress that an obsolete health technology is construed as being one which has been shown to be so after a thorough analysis of the scientific evidence. In this document, a difference will be drawn between "potentially obsolete" and "obsolete" technologies. A potentially obsolete technology is one which is indicated as being possibly obsolete (when such obsolescence is identified) after the process of detection, while an obsolete technology is one which is shown to be obsolete following the issue of a report based on a systematic review.
This guide's priority target is to provide guidance for professionals or institutions that are interested in analysing obsolete health technologies in their respective health care contexts and may wish to explore some facet of this in depth, i.e., identification, prioritisation or assessment.
From its inception, the aim of this guide was to be applicable in both the public and private spheres as well as in different health care systems. It should be noted that, after some discussions, ineffective technologies were not included within the scope of this guide (ineffective technologies being those which have not shown their effectiveness but are routinely used in health care). Similarly, inefficient technologies do not come within the objectives of the guide: inefficient technologies are those whose benefit is obtained at the expense of a considerable consumption of resources (in terms of time, cost, staff or a combination of all three). This document is not targeted at disinvestment from technologies despite the fact that this is a secondary objective, since obsolescence is inescapably linked to disinvestment. However, the term "disinvestment" implicitly entails the assessment or connotation of cost-effectiveness, which is not the purpose of this guide.