PMID- 28065172
OWN - NLM
STAT- MEDLINE
DCOM- 20170710
LR  - 20170713
IS  - 1471-6348 (Electronic)
IS  - 0266-4623 (Linking)
VI  - 32
IP  - 6
DP  - 2016 Jan
TI  - INCORPORATING ENVIRONMENTAL OUTCOMES INTO A HEALTH ECONOMIC MODEL.
PG  - 400-406
LID - 10.1017/S0266462316000581 [doi]
AB  - OBJECTIVES: 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. METHODS: 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. 
      RESULTS: 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. CONCLUSIONS: 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.
FAU - Marsh, Kevin
AU  - Marsh K
AD  - Modelling and Simulation,Eviderakevin.marsh@evidera.com.
FAU - Ganz, Michael
AU  - Ganz M
AD  - Real-World Evidence,Evidera.
FAU - Nortoft, Emil
AU  - Nortoft E
AD  - Global Health Economics and Outcomes Research,Novo Nordisk.
FAU - Lund, Niels
AU  - Lund N
AD  - Novo Nordisk.
FAU - Graff-Zivin, Joshua
AU  - Graff-Zivin J
AD  - Department of Economics,University of California San Diego.
LA  - eng
PT  - Journal Article
DEP - 20170109
PL  - England
TA  - Int J Technol Assess Health Care
JT  - International journal of technology assessment in health care
JID - 8508113
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
RN  - 142M471B3J (Carbon Dioxide)
SB  - IM
MH  - Administration, Oral
MH  - Carbon Dioxide/*analysis
MH  - Cost-Benefit Analysis
MH  - Diabetes Mellitus, Type 2/drug therapy/economics
MH  - Drug Therapy, Combination
MH  - Environmental Health/economics/*methods
MH  - Humans
MH  - Hypoglycemic Agents/economics/therapeutic use
MH  - Insulin/economics/therapeutic use
MH  - Models, Econometric
MH  - Technology Assessment, Biomedical/*methods
OTO - NOTNLM
OT  - Economic evaluation
OT  - Environmental impacts
OT  - Health technology assessment
EDAT- 2017/01/10 06:00
MHDA- 2017/07/14 06:00
CRDT- 2017/01/10 06:00
PHST- 2017/01/10 06:00 [pubmed]
PHST- 2017/07/14 06:00 [medline]
PHST- 2017/01/10 06:00 [entrez]
AID - S0266462316000581 [pii]
AID - 10.1017/S0266462316000581 [doi]
PST - ppublish
SO  - Int J Technol Assess Health Care. 2016 Jan;32(6):400-406. doi: 
      10.1017/S0266462316000581. Epub 2017 Jan 9.