Exploring Methods to Include Carbon Emissions Into a Health Technology Assessment: The Case of Remote Patient Monitoring

Value in Health, vol. 29, pp. 641–649

Abstract

OBJECTIVES: To examine how 2 methodological approaches can be applied to incorporate environmental outcomes in Health Technology Assessment, using remote patient monitoring (RPM) versus usual care (UC) after cardiac surgery. METHODS: eq; scenario analysis up to €0.21/kg) and added to costs. In multicriteria decision analysis (MCDA), 6 criteria including environmental impact were evaluated with Analytical Hierarchy Process, using stakeholder valuations. RESULTS: eq per patient), driven by device production, partly offset by reduced unplanned care, outpatient visits, and patient travel. Despite higher emissions, RPM remained cost-saving (€102 per patient) with a positive incremental net monetary benefit (€42); only 1% of cost difference was attributable to emissions. In the MCDA, RPM outperformed UC in 5 of 6 criteria, with UC only favored on environmental impact. Stakeholders assigned moderate weight to the environmental criterion, resulting in a higher overall value score for RPM (0.649 vs 0.351). CONCLUSIONS: Both methods were feasible and, despite RPM's higher carbon emissions, pointed to the same conclusion. Economic evaluation had little impact at current carbon prices, whereas MCDA allowed explicit sustainability considerations but is sensitive to subjective choices. Overall, environmental outcomes may be better addressed through deliberative Health Technology Assessment processes, with broader policy instruments key to reducing healthcare's carbon emissions.

Authors 4

1. Sophia L Kingma Aachen Emergency Department

   Leiden University Medical Center

   Affiliation as printed

   Emergency Department, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: s.l.kingma@lumc.nl

2. Egid M van Bree Aachen Centre for Sustainable Healthcare Department of Surgery, Leiden University Medical Center

   Leiden University Medical Center · Amsterdam University Medical Centers

   Affiliation as printed

   Center for Sustainable Healthcare, Amsterdam University Medical Center, Amsterdam, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

   Centre for Sustainable Healthcare, Amsterdam University Medical Center, Amsterdam, The Netherlands & Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

3. Maureen Rutten‐van Mölken

   Erasmus University Rotterdam

   Affiliation as printed

   Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands

   Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands

4. Maarten J. IJzerman

   Erasmus University Rotterdam

   Affiliation as printed

   Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands

   Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands