Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance.
Journal
Applied health economics and health policy
ISSN: 1179-1896
Titre abrégé: Appl Health Econ Health Policy
Pays: New Zealand
ID NLM: 101150314
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
accepted:
12
09
2022
pubmed:
5
10
2022
medline:
14
1
2023
entrez:
4
10
2022
Statut:
ppublish
Résumé
Human health is intrinsically linked with planetary health. But planetary resources are currently being degraded and this poses an existential threat to human health and the sustainability of our healthcare systems. The aims of this study were to (1) describe an approach to integrate environmental impacts in a cost analysis; and (2) demonstrate this approach by estimating select environmental impacts alongside traditional health system and other costs using the example of the pilot MEL-SELF randomised controlled trial of patient-led melanoma surveillance. Economic costs were calculated alongside a randomised trial using standard cost analysis methodology from a societal perspective. Environmental impacts were calculated using a type of carbon footprinting methodology called process-based life cycle analysis. This method considers three scopes of carbon emissions: Scope 1, which occur directly from the intervention; Scope 2, which occur indirectly from the intervention's energy use; and Scope 3, which occur indirectly because of the value chain of the intervention. In this study we only included emissions from patient transport to attend their melanoma clinic over the study period of 6 months. The environmental impact per participant across allocated groups for patient transport to their melanoma clinic was estimated to be 10 kg carbon dioxide equivalent. Economic costs across the allocated groups indicated substantial health system costs, out-of-pocket costs, and productivity losses associated with melanoma surveillance. The largest cost contributor was health system costs, and the most expensive category of health system cost was hospital admission. Calculating environmental impacts is worthwhile and feasible within a cost analysis framework. Further work is needed to address outstanding conceptual and practical issues so that a comprehensive assessment of environmental impacts can be considered alongside economic costs in health technology assessments.
Identifiants
pubmed: 36195819
doi: 10.1007/s40258-022-00765-6
pii: 10.1007/s40258-022-00765-6
pmc: PMC9834124
doi:
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
23-30Subventions
Organisme : Faculty of Medicine and Health, University of Sydney
ID : Research Centres Stipend Scholarship SC1647
Organisme : National Health and Medical Research Council
ID : Project Grant 1163054
Organisme : National Health and Medical Research Council
ID : Investigator Grant 1174523
Organisme : National Health and Medical Research Council
ID : Fellowship 1194703
Organisme : University of Sydney
ID : Robinson Fellowship
Informations de copyright
© 2022. The Author(s).
Références
Whitmee S, Haines A, Beyrer C, Boltz F, Capon AG, de Dias BFS, et al. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation-Lancet Commission on planetary health. The Lancet. 2015;386(10007):1973–2028.
doi: 10.1016/S0140-6736(15)60901-1
Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health. 2018;2(1):e27-35.
doi: 10.1016/S2542-5196(17)30180-8
NHS England. Delivering a “Net Zero” Health Service [Internet]. 2020 [cited 2022 Feb 24]. https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf .
Eckelman MJ, Sherman J. Environmental impacts of the U.S. Health Care System and Effects on Public Health. PLoS ONE. 2016;11(6):e0157014.
doi: 10.1371/journal.pone.0157014
Mortimer F. The sustainable physician. Clin Med Lond Engl. 2010;10(2):110–1.
doi: 10.7861/clinmedicine.10-2-110
Veidis EM, Myers SS, Almada AA, Golden CD. A call for clinicians to act on planetary health. The Lancet. 2019;393(10185):2021.
doi: 10.1016/S0140-6736(19)30846-3
Mortimer F, Isherwood J, Wilkinson A, Vaux E. Sustainability in quality improvement: redefining value. Future Healthc J. 2018;5(2):88–93.
doi: 10.7861/futurehosp.5-2-88
Mortimer F, Isherwood J, Pearce M, Kenward C, Vaux E. Sustainability in quality improvement: measuring impact. Future Healthc J. 2018;5(2):94–7.
doi: 10.7861/futurehosp.5-2-94
Medical Services Advisory Committee. Guidelines for preparing assessments for the Medical Services Advisory Committee—Version 1.0. Australian Department of Health; 2021.
Vergunst F, Berry HL, Rugkåsa J, Burns T, Molodynski A, Maughan DL. Applying the triple bottom line of sustainability to healthcare research-a feasibility study. Int J Qual Health Care J Int Soc Qual Health Care. 2020;32(1):48–53.
doi: 10.1093/intqhc/mzz049
de Preux L, Rizmie D. Beyond financial efficiency to support environmental sustainability in economic evaluations. Future Healthc J. 2018;5(2):103–7.
doi: 10.7861/futurehosp.5-2-103
Breth-Petersen M, Bell K, Pickles K, McGain F, McAlister S, Barratt A. Health, financial and environmental impacts of unnecessary vitamin D testing: a triple bottom line assessment adapted for healthcare. BMJ Open. 2022;12(8): e056997.
doi: 10.1136/bmjopen-2021-056997
Ackermann DM, Dieng M, Medcalf E, Jenkins MC, van Kemenade CH, Janda M, et al. Assessing the potential for patient-led surveillance after treatment of localized melanoma (MEL-SELF): a pilot randomized clinical trial. JAMA Dermatol. 2022;158(1):33–42.
doi: 10.1001/jamadermatol.2021.4704
Berners-Lee M. How Bad are bananas? Profile Books; 2020. p. 256.
McAlister S, Barratt AL, Bell KJ, McGain F. The carbon footprint of pathology testing. Med J Aust. 2020;212(8):377–382. https://doi.org/10.5694/mja2.50583 .
doi: 10.5694/mja2.50583
Tennison I, Roschnik S, Ashby B, Boyd R, Hamilton I, Oreszczyn T, et al. Health care’s response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health. 2021;5(2):e84-92.
doi: 10.1016/S2542-5196(20)30271-0
McAlister S, McGain F, Breth-Petersen M, Story D, Charlesworth K, Ison G, et al. The carbon footprint of hospital diagnostic imaging in Australia. Lancet Reg Health West Pac. 2022;1(24):100459.
doi: 10.1016/j.lanwpc.2022.100459
Weidema BP. Market information in life cycle assessment [Internet]. Copenhagen: Danish Environmental Protection Agency; 2003 [cited 2022 Aug 30]. Report No.: 836. https://lca-net.com/publications/show/market-information-life-cycle-assessment/ . Accessed 30 Aug 2022.
Australian Bureau of Statistics. Survey of Motor Vehicle Use, Australia. 2020.
Australian Department of Industry Science Energy and Resources. National Greenhouse Accounts Factors. 2021.
Medicare Benefits Schedule Online [Internet]. Australian Government Department of Health and Ageing; http://www.mbsonline.gov.au .
Independent Hospital Pricing Authority. The National Hospital Cost Data Collection (NHCDC), Public Hospitals Round 23 (Financial year 2018–19) [Internet]. 2021 Feb [cited 2022 Aug 25]. https://www.ihacpa.gov.au/resources/national-hospital-cost-data-collection-nhcdc-public-hospitals-round-23-financial-year-2018-19 . Accessed 25 Aug 2022.
Australian Taxation Office. Car expenses [Internet]. 2021. www.ato.gov.au/car . Accessed 25 Aug 2022.
Australian Bureau of Statistics. Employee Earnings and Hours, Australia. 2018.
Deloitte Access Economics. The value of informal care in 2020. 2020.
Australian Bureau of Statistics. Wage Price Index, Australia. 2021.
Purohit A, Smith J, Hibble A. Does telemedicine reduce the carbon footprint of healthcare? A systematic review. Future Healthc J. 2021;8(1):e85-91.
doi: 10.7861/fhj.2020-0080
Li KY, Ng S, Zhu Z, McCullough JS, Kocher KE, Ellimoottil C. Association between primary care practice telehealth use and acute care visits for ambulatory care-sensitive conditions during COVID-19. JAMA Netw Open. 2022;5(3): e225484.
doi: 10.1001/jamanetworkopen.2022.5484
Pekarsky BAK. The inclusion of comparative environmental impact in health technology assessment: practical barriers and unintended consequences. Appl Health Econ Health Policy. 2020;18(5):597–9.
doi: 10.1007/s40258-020-00578-5
Hensher M. Incorporating environmental impacts into the economic evaluation of health care systems: Perspectives from ecological economics. Resour Conserv Recycl. 2020;1(154): 104623.
doi: 10.1016/j.resconrec.2019.104623
Marsh K, Ganz ML, Hsu J, Strandberg-Larsen M, Gonzalez RP, Lund N. Expanding health technology assessments to include effects on the environment. Value Health. 2016;19(2):249–54.
doi: 10.1016/j.jval.2015.11.008
Ackermann DM, Smit AK, Janda M, van Kemenade CH, Dieng M, Morton RL, et al. Can patient-led surveillance detect subsequent new primary or recurrent melanomas and reduce the need for routinely scheduled follow-up? A protocol for the MEL-SELF randomised controlled trial. Trials. 2021;22(1):324.
doi: 10.1186/s13063-021-05231-7
Pharmaceutical Benefits Advisory Committee. Guidelines for preparing submission to the Pharmaceutical Benefits Advisory Committee—Version 5.0. Australian Department of Health; 2016.