Debaveye Sam, De Soete Wouter, De Meester Steven, Vandijck Dominique, Heirman Bert, Kavanagh Shane, Dewulf Jo
Research Group Environmental Organic Chemistry and Technology (EnVOC), Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, Ghent B-9000, Belgium.
Research Group Environmental Organic Chemistry and Technology (EnVOC), Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, Ghent B-9000, Belgium; European Commission, Joint Research Centre, Institute for Environment and Sustainability (IES), Via Enrico Fermi 2749, 21027 Ispra, Italy.
Environ Res. 2016 Jan;144(Pt A):19-31. doi: 10.1016/j.envres.2015.10.027. Epub 2015 Nov 3.
The effects of a pharmaceutical treatment have until now been evaluated by the field of Health Economics on the patient health benefits, expressed in Quality-Adjusted Life Years (QALYs) versus the monetary costs. However, there is also a Human Health burden associated with this process, resulting from emissions that originate from the pharmaceutical production processes, Use Phase and End of Life (EoL) disposal of the medicine. This Human Health burden is evaluated by the research field of Life Cycle Assessment (LCA) and expressed in Disability-Adjusted Life Years (DALYs), a metric similar to the QALY. The need for a new framework presents itself in which both the positive and negative health effects of a pharmaceutical treatment are integrated into a net Human Health effect. To do so, this article reviews the methodologies of both Health Economics and the area of protection Human Health of the LCA methodology and proposes a conceptual framework on which to base an integration of both health effects. Methodological issues such as the inclusion of future costs and benefits, discounting and age weighting are discussed. It is suggested to use the structure of an LCA as a backbone to cover all methodological challenges involved in the integration. The possibility of monetizing both Human Health benefits and burdens is explored. The suggested approach covers the main methodological aspects that should be considered in an integrated assessment of the health effects of a pharmaceutical treatment.
迄今为止，卫生经济学领域一直是根据药物治疗对患者健康的益处（以质量调整生命年（QALYs）表示）与货币成本之比来评估药物治疗效果的。然而，这一过程还伴随着人类健康负担，它源于药品生产过程、使用阶段以及药品报废处置阶段产生的排放。这种人类健康负担由生命周期评估（LCA）研究领域进行评估，并以伤残调整生命年（DALYs）表示，这是一种与QALY类似的指标。于是就需要一个新的框架，将药物治疗的正面和负面健康影响整合为人类健康净效应。为此，本文回顾了卫生经济学和LCA方法中人类健康保护领域的方法，并提出了一个将两种健康影响整合起来的概念框架。文中讨论了诸如纳入未来成本和收益、贴现和年龄加权等方法问题。建议以LCA的结构为基础，以涵盖整合过程中涉及的所有方法挑战。探讨了将人类健康益处和负担货币化的可能性。所建议的方法涵盖了药物治疗健康影响综合评估中应考虑的主要方法方面。
