Marsh Kevin, Ganz Michael, Nørtoft Emil, Lund Niels, Graff-Zivin Joshua
Modelling and Simulation,
Real-World Evidence,Evidera.
Int J Technol Assess Health Care. 2016 Jan;32(6):400-406. doi: 10.1017/S0266462316000581. Epub 2017 Jan 9.
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.
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.
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.
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.
以往大多数卫生技术评估（HTA）的传统经济评估未纳入环境结果。随着人们对减少人类活动环境影响的兴趣日益浓厚，将环境结果纳入HTA的需求也在增加。我们提出了一种简单的方法来实现这一点。
我们调整了现有的临床经济模型以纳入环境结果（二氧化碳[CO₂]排放），从英国支付方的角度预测在30年期间为2型糖尿病（T2DM）患者在口服抗糖尿病药物（OAD）治疗方案中添加胰岛素的后果。流行病学、疗效、医疗成本、效用和碳排放数据均来自已发表的文献。进行了情景分析以探讨参数不确定性的影响。
在OAD治疗方案中添加胰岛素使每位患者的成本增加2668英镑，每位患者的质量调整生命年增加0.36。胰岛素 - OAD联合治疗方案每位患者产生的与治疗和疾病管理相关的CO₂排放量（1686千克）比仅使用OAD治疗方案（310千克）更多，但治疗并发症相关的排放量更少（3019千克对3337千克）。总体而言，在OAD治疗中添加胰岛素在30年内每位患者会额外产生1057千克的CO₂排放。
该模型提供了一种将环境结果纳入卫生经济分析的简单方法，以支持决策者减少医疗保健环境影响的目标。需要进一步开展工作以提高该方法的准确性；特别是生成特定资源的环境影响。
