Beyond financial efficiency to support environmental sustainability in economic evaluations.

The healthcare sector is one of the largest polluters in the UK, accounting for 25% of total emissions of carbon dioxide of the public sector. Ironically, it is the healthcare sector itself that is primarily affected by any deterioration in the environment affecting individuals' health and their demand for healthcare. Therefore, the healthcare sector is a direct beneficiary of its own steps towards sustainability and is more and more viewed as the one who should lead the change. In this article, we first review the concepts of financial and environmental sustainability. Second, we discuss the existing evidence of sustainable changes within this sector. Third, we propose a simple adaptation of the classic cost-effectiveness analysis to incorporate carbon footprinting to account for these external costs. We illustrate our method using the case of in-centre versus home haemodialysis. We conclude that home dialysis is always a preferable alternative to in-centre treatment based on a cost-effectiveness analysis. Finally, we discuss the limitations of our approach and the future research agenda.