In the healthcare sector, medical devices and health technologies are fundamental. In their evaluation, a lot of factors have to be taken into consideration. The evaluation of these products can be made through HTA (i.e. Health Technology Assessment), that has particular relevance in the healthcare literature. In the context of HTA, clinical, economic, technological, organizational, social/socio-cultural, ethical and legal are the different aspects (in a broad sense: domains) considered by stakeholders and decision-makers in the evaluation and consequently decision for the appropriate technology to be adopted in a particular treatment. Among all the aspects aforementioned, the environmental one is not present: Goetghebeur et al. (2017) affirm that “except for environmental impact and nonmedical costs, most criteria were deemed to reflect the values of HTA agencies” (pp.518). The environment, however, has to be considered in HTA: the sustainable health has to be reached also with the consideration of the environmental impact. In HTA, different frameworks and models describes the different aspects of analysis. The research question which was analyzed is the following one: can environmental aspect be relevant in HTA? The methodology adopted in the theis is based on two different researches. In the first part of the work, a systematic literature review, based on a scientific method of working. This allowed a screening of the useful articles to analyze, which are focused on frameworks and domains (or aspects) in HTA field. The conclusion of the first part is the illustration of how poor is the literature in the discussion of the environmental matter in HTA. This is due to the little emphasis on this theme nowadays in the hospitals and in the healthcare agencies in general. In the second research, a collection of data on the environmental question in HTA was obtained through interviews to French and Italian HTA stakeholders, operating in HB-HTA. This is the objective of the second part of the study. Since the topic under analysis is not very developed, and, on the contrary, it is a very little debated issue for now, the best suitable method to adopt for obtaining relevant and reliable data was the qualitative research. In particular, the interview study, with open-ended questions. Interviewees are thus free to organize the answer, without being forced to evaluate existing criteria or to give them a grade. The results are presented in a schematic way, and then they were compared and discussed in the light of the previous literature analysis. The results have highlighted the potential relevance of considering the environmental impact in HTA, and this topic has to be understood and developed in the light of the national and international policies in favour of the environment, in different types of business. The last part of the thesis, ‘Final conclusion’, is an evaluation of the answers received and a discussion on how they improve the existing literature.
Nel settore sanitario, i dispositivi medici e le tecnologie sanitarie sono fondamentali. Nella loro valutazione, molti fattori devono essere presi in considerazione. La valutazione di questi prodotti può essere fatta attraverso l'HTA (cioè Health Technology Assessment), che ha particolare rilevanza nella letteratura sanitaria. Nel contesto dell'HTA, gli aspetti clinici, economici, tecnologici, organizzativi, sociali/socioculturali, etici e legali sono i diversi aspetti (in senso lato: domini) considerati dalle parti interessate e dai decisori nella valutazione e di conseguenza nella decisione per la tecnologia appropriata da adottare in un particolare trattamento. Tra tutti gli aspetti citati, quello ambientale non è presente: Goetghebeur et al. (2017) affermano che "ad eccezione dell'impatto ambientale e dei costi non medici, la maggior parte dei criteri sono stati ritenuti riflettere i valori delle agenzie HTA" (pp.518). L'ambiente, tuttavia, deve essere considerato nell'HTA: la salute sostenibile deve essere raggiunta anche con la considerazione dell'impatto ambientale. Nell'HTA, diversi quadri e modelli descrivono i diversi aspetti dell'analisi. La domanda di ricerca che è stata analizzata è la seguente: l'aspetto ambientale può essere rilevante nell'HTA? La metodologia adottata in questo lavoro si basa su due diverse ricerche. Nella prima parte del lavoro, una revisione sistematica della letteratura, basata su un metodo di lavoro scientifico. Questo ha permesso uno screening degli articoli utili da analizzare, che sono focalizzati su quadri e domini (o aspetti) nel campo dell'HTA. La conclusione della prima parte è l'illustrazione di quanto sia scarsa la letteratura nella discussione della questione ambientale nell'HTA. Questo è dovuto alla poca enfasi su questo tema al giorno d'oggi negli ospedali e nelle agenzie sanitarie in generale. Nella seconda ricerca, una raccolta di dati sulla questione ambientale nell'HTA è stata ottenuta attraverso interviste a stakeholder HTA francesi e italiani, operanti nell'HB-HTA. Questo è l'obiettivo della seconda parte dello studio. Poiché l'argomento in analisi non è molto sviluppato e, anzi, è una questione per ora poco dibattuta, il metodo più adatto da utilizzare per ottenere dati rilevanti e affidabili è stata la ricerca qualitativa. In particolare, lo studio delle interviste, con domande aperte. Gli intervistati sono così liberi di organizzare la risposta, senza essere costretti a valutare i criteri esistenti o a dare un voto ad essi. I risultati sono stati presentati in modo schematico, e poi sono stati confrontati e discussi alla luce della precedente analisi della letteratura. I risultati hanno evidenziato l'importanza nel considerare l'impatto ambientale nell'HTA, e questo tema deve essere compreso e sviluppato alla luce delle politiche nazionali e internazionali a favore dell'ambiente, considerando anche i diversi tipi di business in cui l'aspetto ambientale e sostenibile sta diventando rilevante. L'ultima parte della tesi, "Conclusione finale", è una valutazione delle risposte ricevute e una discussione su come queste migliorano la letteratura esistente.
Impatto ambientale in Health Technology Assessment
SAIA, MATTEO
2020/2021
Abstract
In the healthcare sector, medical devices and health technologies are fundamental. In their evaluation, a lot of factors have to be taken into consideration. The evaluation of these products can be made through HTA (i.e. Health Technology Assessment), that has particular relevance in the healthcare literature. In the context of HTA, clinical, economic, technological, organizational, social/socio-cultural, ethical and legal are the different aspects (in a broad sense: domains) considered by stakeholders and decision-makers in the evaluation and consequently decision for the appropriate technology to be adopted in a particular treatment. Among all the aspects aforementioned, the environmental one is not present: Goetghebeur et al. (2017) affirm that “except for environmental impact and nonmedical costs, most criteria were deemed to reflect the values of HTA agencies” (pp.518). The environment, however, has to be considered in HTA: the sustainable health has to be reached also with the consideration of the environmental impact. In HTA, different frameworks and models describes the different aspects of analysis. The research question which was analyzed is the following one: can environmental aspect be relevant in HTA? The methodology adopted in the theis is based on two different researches. In the first part of the work, a systematic literature review, based on a scientific method of working. This allowed a screening of the useful articles to analyze, which are focused on frameworks and domains (or aspects) in HTA field. The conclusion of the first part is the illustration of how poor is the literature in the discussion of the environmental matter in HTA. This is due to the little emphasis on this theme nowadays in the hospitals and in the healthcare agencies in general. In the second research, a collection of data on the environmental question in HTA was obtained through interviews to French and Italian HTA stakeholders, operating in HB-HTA. This is the objective of the second part of the study. Since the topic under analysis is not very developed, and, on the contrary, it is a very little debated issue for now, the best suitable method to adopt for obtaining relevant and reliable data was the qualitative research. In particular, the interview study, with open-ended questions. Interviewees are thus free to organize the answer, without being forced to evaluate existing criteria or to give them a grade. The results are presented in a schematic way, and then they were compared and discussed in the light of the previous literature analysis. The results have highlighted the potential relevance of considering the environmental impact in HTA, and this topic has to be understood and developed in the light of the national and international policies in favour of the environment, in different types of business. The last part of the thesis, ‘Final conclusion’, is an evaluation of the answers received and a discussion on how they improve the existing literature.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/1245