EXPERT OPINIONS
A range of opinions on obsolete technologies, expressed by a series of authors, can be found in the literature. Thus, Ancellin (20) is of the opinion that the obsolescence of a medical device is defined by: a) loss of its initial performance; b) development of medical techniques that may require a wide spectrum of performance; and, c) presence of new devices with enhanced safety. Plumridge (21) criticises the large amount of inefficient technologies used as well as the diversification of resources. Disinvestment from technologies is complex, requires resources and reveals the wide variations that exist in medical practice coming under the area of health care. Despite these opinions, there is not much literature published that addresses the topic of obsolescence in health technologies in the terms envisaged in this document.
Another group of studies analyses specific health technologies as potentially obsolete. Some of these are shown in Table 1.
| Table 1. Some technologies proposed as obsolete or ineffective. | ||
|---|---|---|
| Technology proposed as obsolete or ineffective | Comparator | Person or body proposing obsolete technology. |
| Extra-intracranial arterial bypass surgery for stroke-prevention treatment. | Not indicated (ineffective) | Medicare (22) |
| Thermography in breast cancer | Not indicated (ineffective) | Medicare (22) |
| Radiography of the lower back for non-specific pain in patients aged 20-49 years | Not indicated (ineffective) | Danish Centre for Evaluation and Health Technology Assessment (DACEHTA) (24) |
| Partial nephrectomy by open surgery for diverse indications | Laparoscopic nephrectomy | Abbou et al. (25) |
| Rigid bronchoscopy | Flexible bronchoscopy | Montero-Cantú et al. (26) |
| Active guidewire catheters for coronary arteriography | Passive guidewire catheters for coronary arteriography | Linnemeier (27) |
| Iterative tubo-ovarian surgery | In vitro fertilisation | Dequesne et al. (28) |
