In the last years, the “One Health” approach started to gain relevance, having the aim of connecting human health, animal health and ecosystem health in an intrinsic way. Considering all the range of current healthcare technology assessment methodologies, it is evident that none of these is able to include the “One Health” approach. The main aim of this Thesis was to understand how to include this model in the evaluation of healthcare technologies. To reach this objective, we propose to employ the SROI (Social Return On Investment) methodology, to evaluate the social, environmental and animal dimensions in the assessment of an investment. This allows to have an overarching evaluation of a technology, considering society, animals and environment as stakeholders. We applied this methodology in the evaluation of an exoskeleton for the upper limb robotic rehabilitation, named AGREE. This technology, that is still in a prototype stage, has been developed by a group of researchers of Politecnico di Milano. Thus, we performed a SROI analysis for a time horizon of five years, both for a single exoskeleton and for a number of exoskeletons estimated on the basis of predicted sales. We identified each stakeholder involved in the rehabilitation activity and estimate their input and outcomes. The results were then integrated with the calculation of the environmental impacts obtained performing the Life Cycle Assessment (LCA) on the exoskeleton using Open LCA as software. The animal dimension was excluded since this technology does not affect them. The final SROI for a single exoskeleton is equal to 2,696 and for the number of predicted exoskeletons to be sold is equal to 1,994, while considering the environmental impact it decreases to 2,694 in the first case and to 1,993 in the second case. Having assumed a good recycling contribution from the exoskeleton, the SROI score shows a very low decrease. The analysis shows the convenience of the technology both under a social and environmental perspective in all the cases analyzed. This proposed methodology, considering the One Health approach, results to be more comprehensive than the current frameworks used to evaluate technologies, contributing to the state of art of the assessment of healthcare technology. Finally, this methodology could be used to support decision-makers in making more comprehensive choices.
Negli ultimi anni ha iniziato ad acquisire sempre più rilevanza l'approccio "One Health", volto a collegare intrinsecamente la salute umana a quella animale e ambientale. Se si considerano tutte le principali metodologie di valutazione delle tecnologie sanitarie, è evidente che nessuna di queste è in grado di integrare l'approccio "One Health". L'obiettivo principale di questa tesi è stato quello di capire come includere questo modello nella valutazione delle tecnologie sanitarie. Per raggiungere questo obiettivo, proponiamo di utilizzare la metodologia SROI (Social Return On Investment), per valutare le dimensioni sociale, ambientale e animale nella valutazione di un investimento. Ciò consente di avere una valutazione globale di una tecnologia, considerando la società, gli animali e l'ambiente come parti interessate. Abbiamo applicato questa metodologia alla valutazione di un esoscheletro per la riabilitazione robotica degli arti superiori, che prende il nome di AGREE. Questa tecnologia, ancora in fase prototipale, è stata sviluppata da un gruppo di ricercatori del Politecnico di Milano. Abbiamo quindi effettuato un'analisi SROI su un orizzonte temporale di cinque anni, sia per un singolo esoscheletro sia per un numero di esoscheletri stimato sulla base delle vendite previste. Abbiamo identificato ogni stakeholder coinvolto nell'attività di riabilitazione e stimato i loro input e outcome. I risultati sono stati poi integrati con il calcolo degli impatti ambientali ottenuti eseguendo il Life-Cycle Assessment (LCA) dell'esoscheletro con il software Open LCA. La dimensione animale è stata esclusa poiché questa tecnologia non la impatta. Lo SROI finale per un singolo esoscheletro è pari a 2.696 e per il numero di esoscheletri che si prevede di vendere è pari a 1.994, mentre considerando l'impatto ambientale il valore diminuisce a 2.694 nel primo caso e a 1.993 nel secondo. Avendo ipotizzato una buona percentuale di riciclo dell'esoscheletro, il punteggio SROI mostra una diminuzione molto bassa. L'analisi mostra la convenienza della tecnologia sia dal punto di vista sociale che ambientale in tutti i casi analizzati. La metodologia proposta, considerando l'approccio One Health, risulta essere più completa rispetto agli attuali framework utilizzati per la valutazione delle tecnologie, contribuendo allo stato dell'arte della valutazione delle tecnologie sanitarie. Infine, questa metodologia potrebbe essere utilizzata per supportare i decisori nel compiere scelte più consapevoli.
Incorporating one health in technology assessment through social return on investment
La Via, Paola;IOVIENO, CARMELA
2021/2022
Abstract
In the last years, the “One Health” approach started to gain relevance, having the aim of connecting human health, animal health and ecosystem health in an intrinsic way. Considering all the range of current healthcare technology assessment methodologies, it is evident that none of these is able to include the “One Health” approach. The main aim of this Thesis was to understand how to include this model in the evaluation of healthcare technologies. To reach this objective, we propose to employ the SROI (Social Return On Investment) methodology, to evaluate the social, environmental and animal dimensions in the assessment of an investment. This allows to have an overarching evaluation of a technology, considering society, animals and environment as stakeholders. We applied this methodology in the evaluation of an exoskeleton for the upper limb robotic rehabilitation, named AGREE. This technology, that is still in a prototype stage, has been developed by a group of researchers of Politecnico di Milano. Thus, we performed a SROI analysis for a time horizon of five years, both for a single exoskeleton and for a number of exoskeletons estimated on the basis of predicted sales. We identified each stakeholder involved in the rehabilitation activity and estimate their input and outcomes. The results were then integrated with the calculation of the environmental impacts obtained performing the Life Cycle Assessment (LCA) on the exoskeleton using Open LCA as software. The animal dimension was excluded since this technology does not affect them. The final SROI for a single exoskeleton is equal to 2,696 and for the number of predicted exoskeletons to be sold is equal to 1,994, while considering the environmental impact it decreases to 2,694 in the first case and to 1,993 in the second case. Having assumed a good recycling contribution from the exoskeleton, the SROI score shows a very low decrease. The analysis shows the convenience of the technology both under a social and environmental perspective in all the cases analyzed. This proposed methodology, considering the One Health approach, results to be more comprehensive than the current frameworks used to evaluate technologies, contributing to the state of art of the assessment of healthcare technology. Finally, this methodology could be used to support decision-makers in making more comprehensive choices.File | Dimensione | Formato | |
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Thesis final 30.11.pdf
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Executive summary.pdf
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Descrizione: Executive Summary
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https://hdl.handle.net/10589/197074