Accounting for planetary boundaries in health economic evaluation

ABSTRACT

Introduction

Health economic evaluation (HEE) provides guidance for decision-making in the face of scarcity but ignores ecological scarcities as long as they involve external costs only. Following the imperative to account for planetary health, this study explores how this blind spot can be addressed.

Areas covered

The study is based on a critical review of relevant work, particularly in the fields of HEE and life cycle assessment (LCA). LCA can provide information on a technology’s environmental impacts which can be accounted for on both the effect and cost sides of HEE. Cost–benefit analyses can incorporate environmental impacts in case vignettes used for eliciting consumers’ willingness to pay. Existing LCA impact models can be used to estimate human health risks associated with environmental impacts and add them to the health benefits in cost-utility analyses. Many jurisdictions offer lists of shadow prices that can be used to incorporate environmental impacts on the cost side of HEE. Also, environmental impacts can be reported in a disaggregated manner.

Expert opinion

Accounting for planetary boundaries is likely to become a key field of methodological innovation in HEE. Decision relevance is likely to be highest for technologies with similar cost-effectiveness but different ecological impacts.

KEYWORDS:

• Health economic evaluation
• planetary health
• sustainability
• green healthcare
• life cycle assessment

Article highlights

• Ecological scarcities have been ignored in cost-effectiveness analyses but can and should be accounted for

• Life cycle analysis (LCA) provides methods that can be used to complement health economic evaluations to achieve this goal

• Planetary health economic evaluation (HEE) could account for ecological impacts both in terms of willingness to pay and quality-adjusted life years (QALY)

• Given that ecological impacts can be estimated on the basis of resource consumption, adding them to the cost side of HEE appears to be the most straightforward way of doing so

• Integrating planetary boundaries is likely to emerge as important methodological innovation in HEE

• Further review is required of the concepts shared by LCA and HEE, the comparison of health economic and LCA health impact models, consensus processes, case studies, and explicit standard setting for methodological decisions that involve value judgments

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This study was conducted as part of regular research activities, funded in terms of regular salary by the author’s institution, University of Bremen. The paper was not funded by any external funding body.