In the last years, the effects of the climate crisis on the environment and living species have become increasingly tangible. Emissions and release of chemicals are damaging ecosystems and substantially increasing the rate of respiratory and infectious diseases, which have never
...
In the last years, the effects of the climate crisis on the environment and living species have become increasingly tangible. Emissions and release of chemicals are damaging ecosystems and substantially increasing the rate of respiratory and infectious diseases, which have never been present previously in some of those regions. This has led to a careful reconsideration of the environmental impact of human activities which highlighted the significant footprint of the healthcare sector, arising a paradox: although it is providing cures and assistance to the population, at the same time this sector is increasing the demand for it by substantially contributing to the total environmental footprint.
Looking at the Netherlands, the healthcare sector is responsible for approximately 7 percent of the national environmental impact in terms of CO2 emission equivalent, 4 percent of the total waste, and 13 percent of the consumption of raw materials. These considerations underpin the necessity to consider this impact in evaluating new interventions in this sector. However, the lack of guidelines, agreement on methodology, and practical examples still represent a substantial barrier to the actual inclusion of sustainability criteria in the economic evaluation
of healthcare interventions.
From this fragmented scenario, two research questions stem: How is it possible to evaluate the environmental footprint of care pathways? And once it has been quantified, how can it be included in the current economic evaluation of the healthcare interventions? In this thesis, answers to these research questions are provided by conducting a case study. It is centered on a chronic disease whose long-term management represents a burden for the Dutch healthcare system both in terms of natural and human resources: Chronic Kidney Disease (CKD). In fact, in the Netherlands, with a prevalence of 8.9 percent, it requires a significant number of healthcare professionals (GP, nephrologist, specialized nurse) and requires extensive natural resources (water, electricity). Therefore, the environmental impact of the care activities involved in the treatment of CKD has been evaluated. In doing
so, a framework has been created to address the first research questions. Following the Sustainable Healthcare Coalition (SHC) guidelines, the entire care pathway has been disassembled into modules, tailored with experts’ help on medical practices followed in the Netherlands. Therefore, next to providing relevant insights into the most environmentally impactful activities in the CKD care pathway, this work contributes to the general knowledge concerning the environmental analysis of the care pathway by providing (for the first time according to the knowledge of this author and the experts involved) a framework applicable, with the necessary modifications of the specific cases, to every chronic disease in the Netherlands. Additionally, to provide an example of how to include environmental impact in the economic evaluation of healthcare intervention, a medicine prescribed to
CKD patients has been chosen: Forxiga.
So far, the few attempts to take into account the environmental footprint of treatment in their economic evaluations have been made by incorporating it as a cost. In this thesis for the first time, next to the inclusion as a cost,
the environmental impact of a medicine has been translated into actual health benefits and incorporated in its economic evaluation. Additionally, an overview of the existing environmental metrics and analyses is presented to provide the reader with a full picture of the current practices.
This study is particularly relevant for several stakeholders. In the first place, its insights concerning the most polluting segments of the care pathway may be very valuable to steering policymakers’ future strategies to reduce emissions and to emit guidelines in this field. Next to that, the information presented in this work may create a competitive advantage for (bio)pharmaceutical companies which can make their production and distribution processes more sustainable thereby addressing the general public’s concerns about the footprint of the sector. Additional beneficiaries of this study are health insurance providers and other healthcare payers who can utilize its results in the negotiation process with (bio)pharmaceutical companies.
This study shows that carrying out an LCA (which is not a common healthcare practice yet) for care pathways is feasible and valuable. In addition, it shows the added value of including the environmental impact of medicines in their economic evaluation so to provide a more comprehensive assessment. However, despite the relevance and the added value, some limitations have been identified. Carrying out an LCA is a resource-intensive and time-consuming activity that many companies often cannot afford. It is a data-driven analysis that is severely hindered by the lack of knowledge-sharing within the healthcare sector. In the absence of data, this analysis requires several assumptions and involves many proxies that undermine the reliability of its results.
