Table 3

Outcomes measured in the study articles

Study context	Outcome measure	Articles	Findings	Numeric results	Direction
HTA	Total cost of new interventions	Barlow et al24	Costs decrease compared with not using HTA	8%–50% lower costs of new treatments depending on the parameter values in the simulation model.	Positive
	Total cost of new interventions	Guthrie31	Potential cost savings in 2/12 case studies	Not reported	Mixed
	Total healthcare spending	Löblova (review)35	Some studies report cost savings, some cost increases	One study found projected annual savings between $16 and $27 million	Mixed
	Usage of new medicine/treatment	Corbacho et al26	Usage of medicine with positive evaluation increases but does not decrease for negative evaluations	Large increase compared with when medicine is not recommended (5–134×) depending on country	Negative
		Bennie et al33	The pattern of use was variable, with the use of some medicines stabilising or declining but others increasing	Before and after total cost for 10 medicines	Mixed
		Zechmeister and Schumacher34	HTA for new treatments did not always impact microlevel decision-making. HTA for old treatments reduced spending when used for disinvestment. Some HTA had no effect.	HTA for new treatment: 45% of hospital decisions were in line with the HTA recommendations HTA for disinvestments: use of all treatments except one decreased significantly resulting in cost savings of €112 000– M€12	Mixed
	Inequality index (opportunity cost)	Love-Koh et al27	Some interventions decreased inequality, some increased it, and some even decreased population health	Net health benefit ranged from −10 919 to 62 745 Slope index of inequality reduction ranged from 5.5 to –8.5	Mixed
Opportunity cost	Change in total costs	Wammes et al25	Increased costs	Not reported	Negative
	Displacement of services	Wammes et al25	No displacement	Not reported	Negative
	Displacement of services	Karlsberg Schaffer et al29	No displacement linkable to new treatments	Not reported	Negative
	Increased efficiency	Wammes et al25	Efficiency measures taken	Not reported	Positive
	Increased efficiency	Karlsberg Schaffer et al29	Efficiency savings obtained (due to all kinds of cost pressures)	Not reported	Positive
	Service coverage versus cost coverage	van der Wees et al30	No direct relationship between breadth of service coverage and level of public spending on healthcare	Not applicable	Mixed
Disinvestment programmes	Cost savings	Peng Lim et al28	Savings achieved	A reduction of up to 50% in the target technology (for one technology only small reduction)	Positive
	Cost savings	Polisena et al (review)37	Potential savings identified by 10/14 studies	$C23 110 (US$18 484 in 2012) to $A50 600 000	Mixed
	Use of the low-value interventions	Chambers et al (review)36	The use of 38% of low-value services in the studies declined	Not reported	Mixed
PBMA	Changes in budget allocations	Cornelissen et al10	Potential investments and disinvestments identified; however, no clear evidence whether financial resources were reallocated as a result	List of $760 000 worth of investment proposals and $38 000 of disinvestment proposals	Negative
PBMA	Changes in service use	Goodwin and Frew32	Elective and non-elective admissions and visits decreased more than national average	Elective admissions −17% Elective day care +3.3% Elective total admissions −2% Non-elective admissions −12% First outpatient attendances −3 %	Positive

HTA, health technology assessment; PBMA, programme budgeting and marginal analysis.