Background: Disinvestment emerged from existing HTA activities and refers to the evaluation of technologies in the last stage of their lifecycle. Many technologies currently in use have never been assessed; therefore disinvestment is gaining international attention as a policy approach for more efficient use of healthcare resources.

Methods: A systematic literature review was conducted to investigate internationally used concepts of disinvestment, existing frameworks and guidelines for identification, assessment and dissemination of disinvestment recommendations. Four countries (England, Spain, Australia and Canada) were chosen for analysis.

Results: The results show that disinvestment policies are still at the developing/piloting phase and no comprehensive framework was found at the national level in any of the four countries. The lack of dedicated resources, published evidence and of methodological frameworks, as well as multiple interests of various stakeholders and the potential duplication of efforts was identified as main challenges for the implementation of disinvestment activities.

Discussion: Key factors facilitating the implementation of disinvestment strategies are a transparent framework, commitment from all stakeholders involved, a long term strategy, additional resources and international collaboration. Best practice model for other countries to follow cannot be determined yet, though results and evaluations of ongoing projects are expected to provide more detailed insights.