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Background The current economic context calls for rationalizing health resources that can be pursued through disinvestment from low value health technologies to invest in the best performing ones, ensuring high healthcare quality. Oncology is a field where, because of high costs of health technologies and rapid innovation, disinvestment is crucial. Methods On this basis, the research team investigated through a survey, based on a questionnaire, opinions and views of representatives of European countries about disinvestment, in terms of fields of application, potential advocates and barriers, specifically focusing on cancer care. Results A total of 17 questionnaires were filled in (response rate: 32.1%). The survey showed disinvestment is applied in several countries as a tool for containing health care expenditures and identifying obsolete technologies/ineffective interventions. Clinicians' resistance to change and industries' opposition are recognized as the most important barriers to the implementation of disinvestment policies. Potential targets of disinvestment in cancer are seen in diagnostic and therapeutic areas. Conclusion Despite the agreement on fields of waste and of disinvestment policies, operational methods to put disinvestment in place are lacking. Since they should rely on an inclusive assessment of the technology, Health Technology Assessment may represent a good approach. [ABSTRACT FROM AUTHOR]

Summary: Detection and eradication of meticillin-resistant Staphylococcus aureus (MRSA) represents a public health priority worldwide. Our aim was to do a systematic review and meta-analysis of randomised, non-randomised, and observational studies to summarise the available evidence on the effect of MRSA detection by rapid screening tests on hospital-acquired MRSA infections and acquisition rate. Eligible studies were retrieved from Medline, EmBase, Science Citation Index, and the Cochrane database. We judged as eligible those studies that compared hospitals and wards in which active screening for the detection of MRSA carriers was done at hospital admission by use of a rapid molecular test to those in which active screening was done with culture alone or not at all. To account for statistical heterogeneity between studies, random-effects models were used. Ten studies (nine interventional studies and one unblinded, cluster-randomised, crossover trial) were reviewed. Meta-analysis was done for studies reporting data on the same outcome. Primary outcomes included MRSA acquisition rate per 1000 patient-days (four studies); incidence of MRSA bloodstream infections per 1000 patient-days (three studies); and incidence of MRSA surgical-site infections per 100 surgical procedures (five studies). Compared with culture screening, use of rapid screening tests was not associated with a significant decrease in MRSA acquisition rate (risk ratio 0·87, 95% CI 0·61–1·24). Between wards applying rapid screening tests and those not applying screening, we noted a significantly decreased risk for MRSA bloodstream infections (0·54, 95% CI 0·41–0·71), but not for MRSA surgical-site infections (0·69, 95% CI 0·46–1·01). We conclude that active screening for MRSA is more important than the type of test used. Since important and costly decisions, such as mandatory legislation for MRSA universal screening, are under consideration in many countries worldwide, policy makers should be aware of the limits and the heterogeneity of the available evidence. [Copyright &y& Elsevier]