“I don’t know of any explicit framework”: exploring stakeholder perspectives of health technology reassessment and disinvestment in medicines in Ireland

There is currently no explicit, formal framework or tool to guide Health Technology Reassessment (HTR) and disinvestment decision-making in Ireland. This study aimed to explore the views and experiences of stakeholders involved in HTR and disinvestment decision-making in Ireland, with a focus on disinvestment from low-value medicines, and to identify participants' awareness of past and current policies, practices, and perceived opportunities for HTR and disinvestment in Ireland. A qualitative study design was employed with semi-structured interviews conducted with 15 stakeholders drawn across the Irish public health system between May and September 2025. The interviews were recorded, transcribed verbatim and analysed thematically using NVivo 14 software. Three overarching themes and nine subthemes were identified. The three themes were “Understanding HTR and disinvestment”, “Implementing HTR and disinvestment in practice” and “Barriers, enablers and trust”. Participants gave examples of past and present disinvestment-related policies in Ireland and suggested potential triggers for identifying low-value medicines. Across stakeholder groups, the clinical needs of the patient were consistently emphasized as taking precedence over financial costs. This study sought to improve our understanding of the HTR and disinvestment landscape in Ireland but has implications for similar health systems internationally. The findings can inform the development of a tailored HTR and disinvestment framework for Irish decision-making relating to low-value medicines.