Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance

Abstract

Aims Human health is intrinsically linked with planetary health. But planetary resources are currently being degraded and this poses an existential threat to human health and the sustainability of our healthcare systems. The aims of this study were to (1) describe an approach to integrate environmental impacts in a cost analysis; and (2) demonstrate this approach by estimating select environmental impacts alongside traditional health system and other costs using the example of the pilot MEL-SELF randomised controlled trial of patient-led melanoma surveillance. Methods Economic costs were calculated alongside a randomised trial using standard cost analysis methodology from a societal perspective. Environmental impacts were calculated using a type of carbon footprinting methodology called process-based life cycle analysis. This method considers three scopes of carbon emissions: Scope 1, which occur directly from the intervention; Scope 2, which occur indirectly from the intervention's energy use; and Scope 3, which occur indirectly because of the value chain of the intervention. In this study we only included emissions from patient transport to attend their melanoma clinic over the study period of 6 months. ResultsThe environmental impact per participant across allocated groups for patient transport to their melanoma clinic was estimated to be 10 kg carbon dioxide equivalent. Economic costs across the allocated groups indicated substantial health system costs, out-of-pocket costs, and productivity losses associated with melanoma surveillance. The largest cost contributor was health system costs, and the most expensive category of health system cost was hospital admission. Conclusion Calculating environmental impacts is worthwhile and feasible within a cost analysis framework. Further work is needed to address outstanding conceptual and practical issues so that a comprehensive assessment of environmental impacts can be considered alongside economic costs in health technology assessments.

Sustainability in Healthcare: Methods and Tools for the Assessment

“…The main topics of remaining 31 studies are included in Figure 2. Half articles (n = 25; 50%) concern care processes and hospital activities and principally investigate wastes (n = 7 [4,[8][9][10][11][12][13]) or transportations phases (n = 1 [14]), the impact generated by a set of activities (n = 11 [15][16][17][18][19][20][21][22][23]), by a hospital (n = 4 [2,7,[24][25]) or by a public health (n = 2 [26][27]). In these studies, methodologies are not concordant.…”

Perspectives and Experiences of Patient-Led Melanoma Surveillance Using Digital Technologies From Clinicians Involved in the MEL-SELF Pilot Randomized Controlled Trial: Qualitative Interview Study

“…Finally, the findings of our study are influenced by the health system context in which the clinicians work. Although in Australia, community-based health care receives public subsidy through the Medicare Benefits Scheme, there are still significant out-of-pocket costs, on average AU $183 (US$124) over 6 months for patients in the MEL-SELF pilot trial [ 46 ]. All clinics involved in the study are privately operated and charge a fee for service.…”