Pugliesi Paul-Simon, Frick Hervé, Guillot Stéphanie, Ferrare Karine, Renzullo Catherine, Benoist Alexandre, Ribes Serge, Beltramo Guillaume, Maldiney Thomas, Ter Schiphorst Romain, Abdul Malak Caroline, Bevand Adrien, Marrauld Laurie, Lejeune Catherine
Department of Intensive Care, William Morey Hospital, Chalon sur Saône, France.
Department of Sustainable Development, William Morey Hospital, Chalon sur Saône, France.
Appl Health Econ Health Policy. 2025 Mar;23(2):265-275. doi: 10.1007/s40258-024-00933-w. Epub 2024 Dec 30.
Economic evaluation aims to compare the costs and results of health strategies to inform public decision making. Although sometimes suggested, until now no national evaluation agency has recommended formally incorporating the cost of greenhouse gas (GHG) emissions generated by health interventions into the estimation of healthcare costs.
The objective of this study was to test and discuss the feasibility of estimating and including the contribution of GHG emissions cost to the total cost of a surgical intervention, with the example of robot-assisted total knee arthroplasty (RTA), using a micro-costing approach.
The study was conducted in June 2022 at the William Morey Hospital (France). Data regarding all of the resources (labor, medical equipment, consumables), as well as energy consumption, staff commuting and waste treatment were collected and valued from the hospital point of view. Greenhouse gas emissions were valued using a cost-effectiveness approach. Several sensitivity analyses were performed.
The mean cost per patient of an RTA was estimated to be €4755.65, of which €152.64 (3.21 %) would be attributable to GHG emissions. The contribution of GHG emissions in the overall cost of a health intervention was highly dependent on the convention used for the price of carbon.
Despite persistent theoretical and practical challenges, adding the estimation of GHG emission costs in the economic evaluation of health interventions may provide institutional decision makers with information that allows them to allocate the public healthcare resources more efficiently.
经济评估旨在比较卫生策略的成本与结果，为公共决策提供依据。尽管有时会有人提出建议，但到目前为止，尚无国家评估机构正式建议将卫生干预措施产生的温室气体（GHG）排放成本纳入医疗成本估算中。
本研究的目的是通过机器人辅助全膝关节置换术（RTA）的实例，采用微观成本核算方法，测试并讨论估算温室气体排放成本对手术干预总成本的贡献并将其纳入其中的可行性。
该研究于2022年6月在法国威廉·莫雷医院进行。从医院角度收集并评估了所有资源（劳动力、医疗设备、耗材）以及能源消耗、员工通勤和废物处理的数据。使用成本效益方法对温室气体排放进行估值。进行了多项敏感性分析。
RTA每位患者的平均成本估计为4755.65欧元，其中152.64欧元（3.21%）可归因于温室气体排放。温室气体排放在卫生干预总体成本中的贡献高度依赖于所用的碳价格公约。
尽管存在持续的理论和实际挑战，但在卫生干预的经济评估中增加温室气体排放成本的估算，可能会为机构决策者提供信息，使他们能够更有效地分配公共医疗资源。
