28 results found
de Preux L, Rizmie D, 2021, How is the healthcare sector dealing with climate change?, Economics Observatory, Vol: 2021
Healthcare systems face a growing burden from environmental hazards like air pollution and extreme weather events. As major contributors to greenhouse gas emissions, they are also seeking to reduce their carbon footprint.
Patel N, Yung N, Vigneswaran G, et al., 2021, 1-year cost-utility analysis of prostate artery embolization (PAE) versus transurethral resection of the prostate (TURP) in benign prostatic hyperplasia (BPH), BMJ Surgery, Interventions, & Health Technologies, Vol: 3, Pages: e000071-e000071, ISSN: 2631-4940
Objective To determine whether prostate artery embolization (PAE) is a cost-effective alternative to transurethral resection of the prostate (TURP) in the management of benign prostate hyperplasia (BPH) after 1-year follow-up.Design, setting and main outcome measures A retrospective cost-utility analysis over a 12-month time period was conducted to compare the two interventions from a National Health Service perspective. Effectiveness was measured as quality-adjusted life years (QALYs) derived from data collected during the observational UK Register of Prostate Embolisation (UK-ROPE) Study. Costs for both PAE and TURP were derived from University Hospital Southampton, a tertiary referral centre for BPH and the largest contributor to the UK-ROPE. An incremental cost-effectiveness ratio (ICER) was derived from cost and QALY values associated with both interventions to assess the cost-effectiveness of PAE versus TURP. Further sensitivity analyses involved a decision tree model to account for the impact of patient-reported complications on the cost-effectiveness of the interventions.Results The mean patient age for TURP (n=31) and PAE (n=133) was 69 and 65.6 years, respectively. In comparison to TURP, PAE was cheaper due to shorter patient stays and the lack of necessity for an operating theatre. Analysis revealed an ICER of £64 798.10 saved per QALY lost when comparing PAE to TURP after 1-year follow-up.Conclusion Our findings suggest that PAE is initially a cost-effective alternative to TURP for the management of BPH after 1-year follow-up. Due to a higher reintervention rate in the PAE group, this benefit may be lost in subsequent years.Trial registration number NCT02434575.
Riley R, de Preux L, Capella P, et al., 2021, How do we effectively communicate air pollution to change public attitudes and behaviours? A review, Sustainability Science, Vol: 16, Pages: 2027-2047, ISSN: 1862-4065
Solutions that engage the public are needed to tackle air pollution. Technological approaches are insufficient to bring urban air quality to recommended target levels, and miss out on opportunities to promote health more holistically through behavioural solutions, such as active travel. Behaviour change is not straightforward, however, and is more likely to be achieved when communication campaigns are based on established theory and evidence-based practices. We systematically reviewed the academic literature on air pollution communication campaigns aimed at influencing air pollution-related behaviour. Based on these findings, we developed an evidence-based framework for stimulating behaviour change through engagement. Across the 37 studies selected for analyses, we identified 28 different behaviours assessed using a variety of designs including natural and research-manipulated experiments, cross-sectional and longitudinal surveys and focus groups. While avoidance behaviour (e.g. reducing outdoor activity) followed by contributing behaviours (e.g. reducing idling) were by far the most commonly studied, supporting behaviour (e.g. civil engagement) shows promising results, with the added benefit that supporting local and national policies may eventually lead to the removal of social and physical barriers that prevent wider behavioural changes. Providing a range of actionable information will reduce disengagement due to feelings of powerlessness. Targeted localized information will appear more immediate and engaging, and positive framing will prevent cognitive dissonance whereby people rationalize their behaviour to avoid living with feelings of unease. Communicating the co-benefits of action may persuade individuals with different drivers but as an effective solution, it remains to be explored. Generally, finding ways to connect with people’s emotions, including activating social norms and identities and creating a sense of collective responsibility, provide prom
Shabir H, Hashemi S, Adelowo T, et al., 2021, Cost-utility analysis of oxybutynin vs. onabotulinumtoxinA (Botox) in the treatment of overactive bladder syndrome, International Journal of Environmental Research and Public Health, Vol: 18, Pages: 1-15, ISSN: 1660-4601
Background: The UK National Health Service (NHS) propose the use of oxybutynin prior to onabotulinumtoxinA (Botox) in the management of overactive bladder syndrome (OAB). Oxybutynin is costly and associated with poor adherence, which may not occur with Botox. We conducted a cost-utility analysis (CUA) to compare the medications. Methods: we compared the two treatments in quality-adjusted life years (QALYS), through the NHS’s perspective. Costs were obtained from UK-based sources and were discounted. Total costs were determined by adding the treatment cost and management cost for complications on each branch. A 12-month time frame was used to model the data into a decision tree. Results: Our results found that using Botox first-line had greater cost utility than oxybutynin. The health net benefit calculation showed an increase in 0.22 QALYs when Botox was used first-line. Botox also had greater cost-effectiveness, with the exception of pediatric patients with an ICER of £42,272.14, which is above the NICE threshold of £30,000. Conclusion: Botox was found to be more cost-effective than antimuscarinics in the management of OAB in adults, however less cost-effective in younger patients. This predicates the need for further research to ascertain the age at which Botox becomes cost-effective in the management of OAB.
Ali A, Mobarak Z, Al-Jumaily M, et al., 2021, Cost-utility analysis of antibiotic therapy versus appendicectomy for acute uncomplicated appendicitis, International Journal of Environmental Research and Public Health, Vol: 18, Pages: 1-15, ISSN: 1660-4601
Background: Current UK National Health Service (NHS) guidelines recommend appendicectomy as gold standard treatment for acute uncomplicated appendicitis. However, an alternative non-surgical management involves administrating antibiotic-only therapy with significantly lower costs. Therefore, a UK-based cost-utility analysis (CUA) was performed to compare ap-pendicectomy with an antibiotic-only treatment from an NHS perspective. Methods: This eco-nomic evaluation modelled health-outcome data using the ACTUAA (2021) prospective multi-centre trial. The non-randomised control trial followed 318 patients given either antibiotic therapy or appendicectomy, with quality of life (QOL) assessed using the SF-12 questionnaires adminis-tered 1-year post-treatment. A CUA was conducted over a 1-year time horizon, measuring benefits in quality adjusted life years (QALYs) and costs in pound sterling using a propensity score-matched approach to control for selection based on observable factors. Results: The CUA produced an in-cremental cost-effectiveness ratio (ICER) of −GBP 23,278.51 (−EUR 27,227.80) per QALY. Therefore, for each QALY gained using antibiotic-only treatment instead of appendicectomy, an extra GBP 23,278.51 was saved. Additionally, two sensitivity analyses were conducted to account for post-operative or post-treatment complications. The antibiotic-only option remained dominant in both scenarios. Conclusion: While the results do not rely on a randomized sample, the analysis based on a 1-year follow-up suggested that antibiotics were largely more cost-effective than ap-pendicectomy and led to improved QOL outcomes for patients. The ICER value of −GBP 23,278.51 demonstrates that the NHS must give further consideration to the current gold standard treatment in acute uncomplicated appendicitis.
Behranwala R, Aojula N, Hagana A, et al., 2021, An economic evaluation for the use of decompressive craniectomy in the treatment of refractory traumatic intracranial hypertension, Brain Injury, Pages: 1-9, ISSN: 0269-9052
Objectives : The management of intracranial hypertension is a primary concern following traumatic brain injury. Data from recent randomized controlled trials have indicated that decompressive craniectomy results in some improved clinical outcomes compared to medical treatment for patients with refractory intracranial hypertension post-traumatic brain injury (TBI). This economic evaluation aims to assess the cost-effectiveness of decompressive craniectomy as a last-tier intervention for refractory intracranial hypertension from the perspective of the National Health Service (NHS).Methods: A Markov model was used to present the results from an international, multicentre, parallel-group, superiority, randomized trial. A cost-utility analysis was then carried out over a 1-year time horizon, measuring benefits in quality adjusted life years (QALYs) and costs in pound sterling.Results: The cost-utility analysis produced an incremental cost-effectiveness ratio (ICER) of £96,155.67 per QALY. This means that for every additional QALY gained by treating patients with decompressive craniectomy, a cost of £96,155.67 is incurred to the NHS.Conclusions: The ICER calculated is above the National Institute for Health and Care Excellence (NICE) threshold of £30,000 per QALY. This indicates that decompressive craniectomy is not a cost-effective first treatment option for refractory intracranial hypertension and maximum medical management is preferable initially.
Wagner UJ, Kassem D, Gerster A, et al., 2020, Carbon Footprints of European Manufacturing Jobs: Stylized Facts and Implications for Climate Policy
Bloom C, de Preux L, Sheikh A, et al., 2020, Health and cost impact of stepping down asthma medication for UK patients, 2001–2017: a population-based observational study, PLoS Medicine, Vol: 17, ISSN: 1549-1277
BackgroundGuidelines recommend stepping down asthma treatment to the minimum effective dose to achieve symptom control, prevent adverse side effects, and reduce costs. Limited data exist on asthma prescription patterns in a real-world setting. We aimed to evaluate the appropriateness of doses prescribed to a UK general asthma population and assess whether stepping down medication increased exacerbations or reliever use, as well as its impact on costs.Methods and findingsWe used nationwide UK primary care medical records, 2001–2017, to identify 508,459 adult asthma patients managed with preventer medication. Prescriptions of higher-level medication: medium/high-dose inhaled corticosteroids (ICSs) or ICSs + add-on medication (long-acting β2-agonist [LABA], leukotriene receptor antagonist [LTRA], theophylline, or long-acting muscarinic antagonist [LAMA]) steadily increased over time (2001 = 49.8%, 2017 = 68.3%). Of those prescribed their first preventer, one-third were prescribed a higher-level medication, of whom half had no reliever prescription or exacerbation in the year prior. Of patients first prescribed ICSs + 1 add-on, 70.4% remained on the same medication during a mean follow-up of 6.6 years. Of those prescribed medium/high-dose ICSs as their first preventer, 13.0% already had documented diabetes, cataracts, glaucoma, or osteopenia/osteoporosis. A cohort of 125,341 patients were drawn to assess the impact of stepping down medication: mean age 50.4 years, 39.4% males, 39,881 stepped down. Exposed patients were stepped down by dropping their LABAs or another add-on or by halving their ICS dose (halving their mean-daily dose or their inhaler dose). The primary and secondary outcomes were, respectively, exacerbations and an increase in reliever prescriptions. Multivariable regression was used to assess outcomes and determine the prognostic factors for initiating stepdown. There was no increased exacerbation risk for each possible medication stepdown (ad
Adomako-Mensah V, Belloni A, Blawat A, et al., 2020, The health and social care costs of a selection of health conditions and multi-morbidities
BackgroundMultimorbidity (MM) is the presence of 2 or more long-term health conditions in a singleindividual. It impacts an individual’s quality of life, mental health and wellbeing, dailyfunction, and often results in greater healthcare utilisation the more co-existingconditions they have (1-4). MM is a big challenge facing the NHS, especially givenEngland’s ageing population, with an estimated two-thirds of individuals aged 65 andover having 2 or more long-term conditions (5-6). Yet, little is known about the resourceuse of these patients despite being the group with the largest impact on the NHS andwith the worst health outcomes (7). Existing evidence focuses on specific healthconditions and their interactions with other conditions using different methodologies,making comparisons across different conditions difficult.This work has empirically assessed the impact of multi-morbidity on NHS and socialcare costs. With the aim of answering the question: is the impact of developing acondition on health and social care costs greater for someone with no prior conditions,or for someone with an existing condition. If patients have multiple conditions, theremay be some economies of scale involved with treatment, for example they may beable to discuss multiple queries during a single GP appointment, or in some cases thetreatment provided will address multiple conditions. However, treating patients withmulti-morbidities could theoretically also be more expensive than treating 2 conditionsseparately, as patients may be more likely to experience complications.MethodologyThis work considered the individual cost of 11 health conditions with high prevalence inthe English population and their most common interactions. These were: chronicobstructive pulmonary disease (COPD), diabetes (types 1 and 2), lung cancer, breastcancer, coronary heart disease (CHD), stroke, hypertension, dementia, liver disease,depression and colorectal cancer.This project had 2 components: a lite
Rizmie D, Miraldo M, Atun R, et al., 2019, The effect of extreme temperature on emergency admissions across vulnerable populations in England: an observational study, Lancet Public Health Science 2019 Conference, Publisher: Elsevier, Pages: S7-S7
BackgroundClimate change poses an unfamiliar challenge to population health and health-systems resilience. Although previous studies have estimated morbidity attributable to heat or cold across cities, we provide, to our knowledge, the first large-scale, population-wide assessment of the effect of extreme temperatures on excess emergency admissions in England and among vulnerable populations, who could be disproportionately affected.MethodsIn this observational study, we combined all daily inpatient admissions during 2001–12 in England with meteorological data using inverse distance weighting. We exploited random daily variation in temperature experienced by hospitals and a 30-day lag period, using a distributed lag model with multiple fixed-effects controlling for seasonal factors, to examine interaction effects across diseases with age and the indices of multiple deprivation.FindingsWe analysed 29 371 084 emergency admissions. A day with temperature above 30°C was associated with 3·5 more admissions per hospital (SE 0·45), relative to a 10–15°C day. This increased to 14·1 excess admissions per hospital (SE 5·56) over the following 30 days, generating 786 excess admissions across England per heatwave day. A day under –5°C generated 3·8 more admissions per hospital (SE 0·33), or 966 excess admissions across England. This increased to 62·3 admissions per hospital (SE 4·83) over the following 30 days. These effects were heterogeneous across age and deprivation level. Populations older than 74 years were up to 8 times more affected by extreme temperatures. Individuals living in low-employment and low-income areas were 2–10 times more likely to be admitted during a temperature shock. These results were statistically significant (p<0·0001) and passed several robustness and falsification tests.InterpretationTo our knowledge, this is the first study to determine heterogene
Fecht D, Sheridan CE, Roscoe CJ, et al., 2019, Inequalities in exposure to nitrogen dioxide in parks and playgrounds in Greater London, International Journal of Environmental Research and Public Health, Vol: 16, Pages: 1-11, ISSN: 1660-4601
Elevated levels of nitrogen dioxide (NO2) have been associated with adverse health outcomes in children including reduced lung function and increased rates of asthma. Many parts ofLondon continue to exceed the annual average NO2 concentration of 40µg/m3 set by the EU directive. Using high-resolution maps of annual average NO2 for 2016 from the London Atmospheric Emissions Inventory and detailed maps of open spaces from Britain’s national mapping agency, Ordnance Survey, we estimated average NO2 concentrations for every open space in Greater London and analysed geospatial patterns comparing Inner verses Outer London and the 32 London Boroughs. Across Greater London, 24% of play spaces, 67% of private parks and 27% of public parks had average levels of NO2 that exceeded the EU limit for NO2. Rates of exceedance were higher in Inner London; open spaces in the City of London had the highest average NO2 values among all the London Boroughs. The closest play space for more than 250,000 children (14%) under 16 years old in Greater London had NO2 concentrations above recommended levels. Of these children, 66% (~165,000 children) live in the most deprived areas of London as measured by the Index of Multiple Deprivations where average NO2 concentrations in play spaces where on average 6 µg/m3 higher than for play spaces in the least deprived quintile. More action is needed to reduce NO2 in open spaces to safe levels through pollution reduction and mitigation efforts as currently open spaces in Greater London including play spaces, parks and gardens still have dangerously high levels of NO2 according to the most recent NO2 map.
Pimpin L, Retat L, Fecht D, et al., 2018, Estimating the costs of air pollution to the National Health Service and social care: An assessment and forecast up to 2035, PLoS Medicine, Vol: 15, ISSN: 1549-1277
BACKGROUND: Air pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England. METHOD AND FINDINGS: Air pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline 'no change' scenario; (2) individuals' pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data. CONCLUSIONS: Approximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure-response functions, as well as to disaggregate results by socioeconomic status.
de Preux LB, Rizmie D, 2018, Beyond financial efficiency to support environmental sustainability in economic evaluations, Future Healthcare Journal, Vol: 5, Pages: 103-107, ISSN: 2055-3323
The healthcare sector is one of the largest pollutersin the United Kingdom, accounting for 25% of total emissions of carbon dioxideof the public sector.Ironically,it is the healthcare sector itself that is primarily affected by any deterioration in the environmentaffectingindividuals’ health and their demand for healthcare.Therefore thehealthcare sector is a direct beneficiary of its own steps towards sustainabilityand is more and more viewed as the one who should lead the change. In this article, we first review the concepts of financial and environmental sustainability.Second,we discuss the existing evidence of sustainablechanges withinthis sector. Third, we propose a simple adaptation of the classic cost-effectivenessanalysis to incorporate carbon footprinting to account for these external costs. We illustrate our method using the case of in-centre versushome haemodialysis. We conclude that home dialysis is always a preferable alternative to in-centre treatment. Finally, we discuss the limitations of our approach, and the future research agenda.
Pimpin L, Retat L, Fecht D, et al., 2018, Estimation of costs to the NHS and social care due to the health impacts of air pollution
de Preux Gallone LB, Sassi F, 2018, Chapter 5 Economics of Pollution Interventions, Chief Medical Officer annual report 2017: health impacts of all pollution – what do we know?, Publisher: Department of Health and Social Care, 5
Interventions to reduce pollution have the potential toincrease social welfare through improvements in health,social and economic outcomes. This potential has beenshown in a range of economic analyses focusing on specificinterventions. In this chapter we present evidence fromstudies focusing on the health impacts of environmentalinterventions that have been evaluated from an economicperspective. Overall, this body of evidence is stronglysuggestive of beneficial welfare impacts from mostinterventions. However, there remains significant scope forexpanding and strengthening the current evidence base inorder to provide clearer guidance to policy makers in policydesign and investment decisions. Salient points made in thischapter include:1) England has successfully managed to “decouple” trendsof economic growth and polluting emissions, achievingreductions in emissions of a large range of pollutants withan expanding economy. However, the detrimental healthimpacts of current levels of pollution are still large, asare the potential benefits of taking more incisive actionsagainst pollution.2) Economic analysis approaches typically applied in theappraisal of environmental interventions are at oddswith those prevailing in the health care domain. A goldstandardeconomic evaluation approach in the area ofenvironmental health interventions should take a societalperspective and aim at assessing overall impacts onsocial welfare. Available evidence neglecting these keycomponents likely underestimates the net benefit ofpollution reduction measures.3) Research priorities should now include the evaluation ofthe societal benefits of measures to address pollutionin order to justify economically beneficial interventionsthat reduce individuals’ pollution exposure or remove thesource of emissions.
Martin R, de Preux LB, Wagner UJ, 2014, The impact of a carbon tax on manufacturing: Evidence from microdata, Journal of Public Economics, Vol: 117, Pages: 1-14, ISSN: 0047-2727
We estimate the impact of a carbon tax on manufacturing plants using panel data from the UK production census. Our identification strategy builds on the comparison of outcomes between plants subject to the full tax and plants that paid only 20% of the tax. Exploiting exogenous variation in eligibility for the tax discount, we find that the carbon tax had a strong negative impact on energy intensity and electricity use. No statistically significant impacts are found for employment, revenue or plant exit.
Martin R, Muûls M, de Preux LB, et al., 2014, On the empirical content of carbon leakage criteria in the EU Emissions Trading Scheme, Ecological Economics, Vol: 105, Pages: 78-88, ISSN: 0921-8009
The EU Emissions Trading Scheme continues to exempt industries deemed at risk of carbon leakage from permit auctions. Carbon leakage risk is established based on the carbon intensity and trade exposure of each 4-digit industry. Using a novel measure of carbon leakage risk obtained in interviews with almost 400 managers at regulated firms in six countries, we show that carbon intensity is strongly correlated with leakage risk whereas overall trade exposure is not. In spite of this, most exemptions from auctioning are granted to industries with high trade exposure to developed and less developed countries. Our analysis suggests two ways of tightening the exemption criteria without increasing relocation risk among non-exempt industries. The first one is to exempt trade exposed industries only if they are also carbon intensive. The second one is to consider exposure to trade only with less developed countries. By modifying the carbon leakage criteria along these lines, European governments could raise additional revenue from permit auctions of up to €3 billion per year, based on a permit price of €30.
Martin R, Muûls M, de Preux LB, et al., 2014, Industry compensation under relocation risk: a firm-level analysis of the EU Emissions Trading Scheme, The American Economic Review, Vol: 104, Pages: 2482-2508, ISSN: 0002-8282
When regulated firms are offered compensation to prevent them from relocating, efficiency requires that payments be distributed across firms so as to equalize marginal relocation probabilities, weighted by the damage caused by relocation. We formalize this fundamental economic logic and apply it to analyzing compensation rules proposed under the EU Emissions Trading Scheme, where emission permits are allocated free of charge to carbon intensive and trade exposed industries. We show that this practice results in substantial overcompensation for given carbon leakage risk. Efficient permit allocation reduces the aggregate risk of job loss by more than half without increasing aggregate compensation.
Muuls M, Martin R, Wagner UJ, et al., 2014, Problematic Permitting - Editor's choice
Martin R, de Preux L, Wagner U, 2012, The polluter-doesn't-pay principle, Publisher: CEP CP 369
Martin R, Muuls M, de Preux L, et al., 2012, Industry Compensation Under Relocation Risk: A Firm-Level Analysis of the EU Emissions Trading Scheme, Publisher: CEP, DP 1150
de Preux LB, 2011, ANTICIPATORY EX ANTE MORAL HAZARD AND THE EFFECT OF MEDICARE ON PREVENTION, HEALTH ECONOMICS, Vol: 20, Pages: 1056-1072, ISSN: 1057-9230
Martin R, de Preux LB, Wagner UJ, 2011, The Impacts of the Climate Change Levy on Manufacturing: Evidence from Microdata
We estimate the impacts of the Climate Change Levy (CCL) on manufacturing plants using panel data from the UK production census. Our identification strategy builds on the comparison of outcomes between plants subject to the CCL and plants that were granted an 80% discount on the levy after joining a Climate Change Agreement (CCA). Exploiting exogenous variation in eligibility for CCA participation, we find that the CCL had a strong negative impact on energy intensity and electricity use. We cannot reject the hypothesis that the tax had no detrimental effects on economic performance and on plant exit.
Anderson B, Leib J, Martin R, et al., 2011, Climate change policy and business in Europe: evidence from interviewing managers
Martin R, Muûls M, Preux LBD, et al., 2011, Anatomy of a paradox: Management practices, organizational structure and energy efficiency, Journal of Environmental Economics and Management, Pages: ---, ISSN: 0095-0696
Martin R, Muuls M, de Preux L, et al., 2010, Anatomy of a Paradox: Management Practices, Organisational Structure and Energy Efficiency, Publisher: CEPDP1039
Martin M, de Preux L, 2009, The Impacts of the Climate Change Levy on business: Evidence from Microdata, Publisher: NBER Working Paper, CEP Working Paper
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