Skip to main content
×
×
Home

INCORPORATING ENVIRONMENTAL OUTCOMES INTO A HEALTH ECONOMIC MODEL

  • Kevin Marsh (a1), Michael Ganz (a2), Emil Nørtoft (a3), Niels Lund (a4) and Joshua Graff-Zivin (a5)...
Abstract

Objectives: Traditional economic evaluations for most health technology assessments (HTAs) have previously not included environmental outcomes. With the growing interest in reducing the environmental impact of human activities, the need to consider how to include environmental outcomes into HTAs has increased. We present a simple method of doing so.

Methods: We adapted an existing clinical-economic model to include environmental outcomes (carbon dioxide [CO2] emissions) to predict the consequences of adding insulin to an oral antidiabetic (OAD) regimen for patients with type 2 diabetes mellitus (T2DM) over 30 years, from the United Kingdom payer perspective. Epidemiological, efficacy, healthcare costs, utility, and carbon emissions data were derived from published literature. A scenario analysis was performed to explore the impact of parameter uncertainty.

Results: The addition of insulin to an OAD regimen increases costs by 2,668 British pounds per patient and is associated with 0.36 additional quality-adjusted life-years per patient. The insulin-OAD combination regimen generates more treatment and disease management-related CO2 emissions per patient (1,686 kg) than the OAD-only regimen (310 kg), but generates fewer emissions associated with treating complications (3,019 kg versus 3,337 kg). Overall, adding insulin to OAD therapy generates an extra 1,057 kg of CO2 emissions per patient over 30 years.

Conclusions: The model offers a simple approach for incorporating environmental outcomes into health economic analyses, to support a decision-maker's objective of reducing the environmental impact of health care. Further work is required to improve the accuracy of the approach; in particular, the generation of resource-specific environmental impacts.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      INCORPORATING ENVIRONMENTAL OUTCOMES INTO A HEALTH ECONOMIC MODEL
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      INCORPORATING ENVIRONMENTAL OUTCOMES INTO A HEALTH ECONOMIC MODEL
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      INCORPORATING ENVIRONMENTAL OUTCOMES INTO A HEALTH ECONOMIC MODEL
      Available formats
      ×
Copyright
References
Hide All
1. Devlin, NJ, Sussex, J. Incorporating multiple criteria in HTA: Methods and processes. London: Office of Health Economics; 2011.
2. Douma, KF, Karsenberg, K, Hummel, MJ, Bueno-de-Mesquita, JM, van Harten, WH. Methodology of constructive technology assessment in health care. Int J Technol Assess Health Care. 2007;23:162168.
3. Marsh, K, Ganz, M, Hssu, J, et al. Health technology assessment and environmental costs: Time for health care to catch up? Value Health. 2014;17:A586.
4. United Nations Framework Convention on Climate Change. Kyoto Protocol. 1997 [cited 2015 February 24]; http://unfccc.int/kyoto_protocol/items/2830.php (accessed February 24, 2015).
5. NHS Sustainable Development Unit. Saving carbon, improving health. Update - NHS Carbon Reduction Strategy. Cambridge: Sustainable Development Unit.
6. Swedish Medical Products Agency. National drug strategy – Action plan. Uppsala, Sweden: Swedish Medical Products Agency; 2011.
8. Marsh, K, Ganz, M, Hssu, J, et al. Expanding health technology assessments to include effects on the environment. Value Health. 2016;19: 249254.
9. Tanios, N, Wagner, M, Tony, M, et al. Which criteria are considered in healthcare decisions? Insights from an international survey of policy and clinical decision makers. Int J Technol Assess Health Care. 2013;29:456465.
10. IPCC. Human health: Impacts, adaptation, and co-benefits. In: Climate Chate 2014: Impacts, adaptation, and vulnerability. Geneva: Intergovernmental Panel on Climate Change; 2014.
11. Costello, A, Abbas, M, Allen, A, et al. Managing the health effects of climate change. Lancet. 2009;373:16931733.
12. World Health Organization. Climate change and health. 2013 [cited 2015 May]; http://www.who.int/mediacentre/factsheets/fs266/en/ (accessed May 20, 2015).
13. Briggs, D. Environmental pollution and the global burden of disease. Br Med Bull. 2003;68:124.
14. Practice Greenhealth. Healthcare energy impacts calculator. Reston, VA: Practice Greenhealth; 2008.
15. Larsen, HN, Solli, C, Pettersena, J. Supply chain management–How can we reduce our energy/climate footprint? Energy Procedia. 2012;20:354363.
16. NHS Sustainable Development Unit. Goods and services carbon hotspots: NHS England breakdown of goods and services carbon footprint by organisation type (Full Report). UK: NHS Shared Business Services; 2012.
17. National Institute for Health and Care Excellence. Type 2 diabetes: The management of Type 2 diabetes. NICE clinical guideline 87. 2009; Modified 2014. London: National Institute for Health and Care Excellence; 2014.
18. Health & Social Care Information Centre. Prescription cost analysis, England - 2014 [NS]. 2015 [cited 2015 April]; http://www.hscic.gov.uk/article/2021/Website-Search?productid=17711&q=prescription+cost+analysis&sort=Relevance&size=10&page=1&area=both#top (accessed April 29, 2015).
19. Palmer, AJ, Roze, S, Valentine, WJ, et al. The CORE Diabetes Model: Projecting long-term clinical outcomes, costs and cost-effectiveness of interventions in diabetes mellitus (types 1 and 2) to support clinical and reimbursement decision-making. Curr Med Res Opin. 2004;20 (Suppl 1):S5S26.
20. McEwan, P, Foos, V, Palmer, JL, et al. Validation of the IMS CORE Diabetes Model. Value Health. 2014;17:714724.
21. NICE. Process and methods guides: Guide to the methods of technology appraisal 2013, National Institute for Health and Care Excellence, Editor. London, UK: National Institute for Health and Care Excellence; 2013.
22. Fritsche, A, Schweitzer, MA, Haring, HU. Glimepiride combined with morning insulin glargine, bedtime neutral protamine hagedorn insulin, or bedtime insulin glargine in patients with type 2 diabetes. A randomized, controlled trial. Ann Intern Med. 2003;138:952959.
23. Pratley, RE, Nauck, M, Bailey, T, et al. Liraglutide versus sitagliptin for patients with type 2 diabetes who did not have adequate glycaemic control with metformin: A 26-week, randomised, parallel-group, open-label trial. Lancet. 2010;375:14471456.
24. Morris, DS, Wright, T, Somner, JE, Connor, A. The carbon footprint of cataract surgery. Eye (Lond). 2013;27:495501.
25. Connor, A, Lillywhite, R, Cooke, MW. The carbon footprint of a renal service in the United Kingdom. QJM. 2010;103:965975.
26. Environmental Protection Agency. Life cycle assessment: Principles and practice by scientific applications international corporation. Cincinnati, OH: Environmental Protection Agency; 2006. http://nepis.epa.gov/Exe/ZyPDF.cgi/P1000L86.PDF?Dockey=P1000L86.PDF (accessed April 29, 2015).
27. Watkiss, P. The Social Costs of Carbon (SCC) review – Methodological approaches for using SCC estimates in policy assessment: Final report. Department for Environment, Editor. Norwich, UK: Office of Public Sector Information; 2005.
28. Nordhaus, WD. Estimates of the social cost of carbon: Background and results from the RICE-2011 model. Cambridge, MA: National Bureau of Economic Research; 2011.
29. Davies, MJ, Chubb, BD, Smith, IC, Valentine, WJ. Cost-utility analysis of liraglutide compared with sulphonylurea or sitagliptin, all as add-on to metformin monotherapy in Type 2 diabetes mellitus. Diabet Med. 2012;29:313320.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Marsh supplementary material
Appendix

 Word (34 KB)
34 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed