Assessing the Environmental-Health-Economic Co-Benefits from Solar Electricity and Thermal Heating in Ulaanbaatar, Mongolia

Rethinking Tuberculosis Morbidity Quantification: A Systematic Review and Critical Appraisal of TB Disability Weights in Cost-Effectiveness Analyses

BACKGROUND

The disability-adjusted life year (DALY), a key metric for health resource allocation, encompasses morbidity through disability weights. Widely used in tuberculosis cost-effectiveness analysis (CEAs), DALYs play a significant role in informing intervention adopt/reject decisions. This study reviews the values and consistency of disability weights applied in tuberculosis-related CEAs.

METHODS

We conducted a systematic review using the Tufts CEA database, updated to July 2023 with searches in Embase, Scopus and PubMed. Eligible studies needed to have included a cost-per-DALY ratio, and additionally either evaluated a tuberculosis (TB) intervention or included tuberculosis-related weights. We considered all tuberculosis health states: with/without human immunodeficiency virus (HIV) coinfection, TB treatments and treatment side effects. Data were screened and extracted independently by combinations of two authors.

FINDINGS

A total of 105 studies spanning 2002-2023 across 50 countries (mainly low- and middle-income countries) were extracted. Disability weights were sourced primarily from the Global Burden of Disease (GBD; 100/165; 61%), with 17 non-GBD studies additionally referenced, along with primary derivation. Inconsistencies in the utilisation of weights were evident: of the 100 usages of GBD-sourced weights, only in 47 instances (47%) had the weight value been explicitly specified with an appropriate up-to-date reference cited (constituting 28% of all weight usages, 47/165). Sensitivity analyses on weight values had been conducted in 30% of studies (31/105). Twelve studies did not clearly specify weights or their sources; nine further calculated DALYs without morbidity. The review suggests methodological gaps in current approaches for representing important aspects of TB, including TB-HIV coinfection, treatment, drug-resistance, extrapulmonary TB and psychological impacts. We propose a set of best practice recommendations.

INTERPRETATION

There is a need for increased rigour in the application, sensitivity testing and reporting of TB disability weights. Furthermore, there appears a desire among researchers to reflect elements of the tuberculosis experience beyond those allowed for by GBD disability weights.

Evaluation of Benefits and Health Co-Benefits of GHG Reduction for Taiwan's Industrial Sector under a Carbon Charge in 2023-2030

The purpose of this paper is to evaluate the monetary GHG reduction benefits and health co-benefits for the industrial sector under the imposition of a carbon charge in Taiwan. The evaluation proceeds from 2023-2030 for different rates of carbon charge for the GHGs by a model of "Taiwan Economic Input Output Life Cycle Assessment and Environmental Value" constructed in this study. It is innovative in the literature to simulate the benefits of GHG reductions and health co-benefits of air pollutions for the industrial sector under the imposition of a carbon charge comprehensively. The results consistently show benefits whether the charge is imposed on the scope 1 and scope 2 GHG emissions or on the scope 1 emissions only. The health co-benefits are on average about 5 times those of GHG reductions benefits in 2023-2030. The average total benefits with the summation of GHG reduction benefits and health co-benefits are 821.9 million US dollars and 975.1 US million US dollars per year, respectively. However, both the GHG reduction benefits and health co-benefits are consistently increasing at a decreasing rate in 2023-2030. The increased multiple for the rate of the carbon charge is higher than the increased multiple of the total benefits and this result shows that the increase of the carbon charge becomes less effective.