在健康技术评估中整合环境影响:一项探索性研究
Coline Ducrot1,2, Julien Péron3,4, Matthieu Delaye5,6
1Orthopedic Surgery Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
医疗保健污染对未来的健康有重大影响,需要纳入成本效益分析. 在卫生技术评估 (HTA) 中考虑温室气体 (GHG) 排放对于评估护理途径和促进可持续医疗保健至关重要.
科学领域:
- 环境健康科学 环境健康科学
- 卫生经济学 卫生经济学
- 公共卫生政策 公共卫生政策
背景情况:
- 医疗保健污染对未来健康的环境影响仍然是护理途径评估中被低估的方面.
- 现有的卫生技术评估 (HTA) 指标可能无法完全捕捉污染物造成的长期健康损害.
研究的目的:
- 制定一个方法框架,将污染物引起的未来健康损害纳入HTA指标中.
- 通过考虑患者的好处和环境成本来评估护理途径的成本效益.
主要方法:
- 利用ReCiPe模型量化美国医疗保健系统污染物的未来健康影响 (DALY),确定温室气体排放为主要关注点.
- 调整了ReCiPe模型以将温室气体排放转换为未来的健康损害 (DALY,QALY,LY) 具有置信区间.
- 将未来的健康损害与患者的利益进行比较 (例如,QALYGHG/QALY患者) 并将损害整合到增量成本效益比率 (ICERGHG).
主要成果:
- 来自美国医疗保健系统的污染物每年估计造成7,363,000 DALY,其中温室气体排放占未来损害的90%以上.
- 提供了将温室气体排放量转换为未来的健康损害的估计,跨越不同的时间和折扣率.
- 将温室气体排放纳入ICER显著影响护理途径的成本效益,可能有利于更绿色的替代方案,并突显低风险人群中慢性治疗的局限性.
结论:
- 为了对健康技术进行全面评估,HTA必须纳入护理途径对未来健康的影响.
- 建议将温室气体排放计算在平等的视角下 (0%的折扣率) 为代际公平.
- 整合温室气体会计可以激励医疗保健提供者和制药公司开发环境可持续的护理途径.
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