A good lesson.

Abstract

Compared to other European countries, the Italian National Health System is under-funded, but despite this central and regional institutions rarely make use of tools and systematic processes for evaluating priorities and innovation. The real risk is that decision makers propose solutions regardless of problem analysis, without using health technology assessment, and cost-effectiveness, cost-benefit, cost-utility analyses. An exemplary case is that of hadron therapy. The indications of use currently provided for in the Italian "Basic healthcare standards" are not supported by scientific evidence. Recent health technology assessments conclude that no sound evidence of superior clinical efficacy and of survival improvement, compared to current best practice, has been produced so far. As existing centers' potential is sufficient to satisfy our current demand, decision makers can only resort to means such as authorization and accreditation to discourage new public and private investments. We should also begin to firmly consider the option of disinvestment, whenever equipment and interventions are found to be ineffective or obsolete.