Integration of Life Cycle Assessment into Health Economic Evaluation: CHEERS ClimatE checklist

Linked Sessions:

Poster Number:  01 

Main Presenter:    Jule Oldenburg;Oliver Lange 

Co-Authors:   Mattis Keil     Wolf Rogowski                                          

The healthcare sector emits 4.4% of global greenhouse gases (GHG). However, the Earth´s capacity to absorb these emissions is a scarce resource. One method for addressing scarce resources in the healthcare sector is health economic evaluation (HEE). It focuses on limited monetary resources by comparing the costs and outcomes of different interventions. The overall measure in HEE is calculated by dividing additional costs by additional effects (e.g. QALY- Quality-Adjusted Life years). Using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) ensures that HEE is recognizable, interpretable, and beneficial for decision-making. In order to establish a healthcare system that aligns with the earth’s capacity for GHG emissions, decision-makers need to consider the carbon footprint (CF) resulting from the climate impacts of the healthcare sector. Consequently, we have included the standards of estimating a CF into CHEERS, resulting in CHEERS Climate Extension (CHEERS
Based on the relevant literature of Life Cycle Assessment (LCA) (e.g. ISO 14067), we mapped relevant CF items to CHEERS. We identified commonalities between CF and HEE, and added necessary missing components to conduct a CF alongside a HEE to CHEERS. Given the importance of digitalization in healthcare, we applied CHEERS ClimatE to a weight loss intervention implemented through a digital health application and a wearable device.
Overall, 17 items of CHEERS remained unchanged. CHEERS ClimatE describes specific criteria for the inclusion of CF in 14 points. Most important for conducting a CF are the changes to item 14, which measures and values the used resources and costs in HEE. We divided it into four sub-items to measure resources in physical units, value them in monetary units, measure the CF, and value CF in external (climate) costs. With CHEERS ClimatE, scarcity can be represented by GHG per additional health outcome (tCO2eq/QALY). Multiplying the GHG by a non-traded price of carbon or the social cost of GHG enables the incorporation of GHG into HEE as climate costs. These costs can be presented per health outcome (€/QALY).
We illustrate how CF can be integrated into HEE to improve decision-making about scarce health resources. However, CHEERS ClimatE exclusively addresses only the CF as one of the impact categories that LCA can conduct. Unlike other (extensions of) reporting standards, one limitation might be the absence of a broader consensus process, such as the Delphi method or focus group. Further research is required to apply and validate CHEERS ClimatE.

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