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  • EQ-5D value set for India: the DEVINE study

    EQ-5D value set for India: the DEVINE study

    Economic Impact of Climate Change on Health Systems

    The Development of an EQ-5D Value Set for India using an Extended Design (DEVINE) study is a major milestone in India’s journey toward evidence-based healthcare decisions.(1) The DEVINE study, authorized by India’s central Health Technology Assessment (HTA) agency, introduced the country’s first EQ-5D-5L value set, which is customized to Indian societal preferences.(2) This is momentous as the EQ-5D-5L instrument, a regulated tool to quantify health-related quality of life (HRQoL), necessitates country-specific value sets to precisely indicate how people value different health states. These value sets are essential for calculating Quality-Adjusted Life Years (QALYs), to eventually support cost-effectiveness analyses and resource allocation in healthcare.(3, 4)

    The study, methodically designed to show India’s huge socio-demographic diversity, was performed across five states using a multistage stratified random sampling method. It surveyed 3,548 adult respondents, the largest ever in an EQ-5D-5L valuation effort undertaken globally. Researchers used computer-assisted personal interviews, merging composite Time Trade-Off (cTTO) and Discrete Choice Experiment (DCE) tasks to obtain health preferences. The study peculiarly used an extended design evaluating 150 distinctive health states, almost twice the number usually integrated in such studies, improving the accuracy and statistical strength of the resulting model. The final value set incorporated a hybrid model, assigning utility values from -0.923 (depicting health states worse than death) to 1 (perfect health), with damages in pain/discomfort being the most significant driver of disutility.(1, 5)

    The DEVINE study also introduced the first set of EQ-5D-5L population norms for India. The mean utility score across the population was 0.848, while the average self-rated health score on the Visual Analog Scale (VAS) was 75.18. These scores showed strong differences by age and gender. Males under 20 years of age showed the highest average utility (0.936), while females over 70 reported the lowest (0.488), depicting a sharp deterioration in perceived health among elderly women. Pain/discomfort and anxiety/depression were the most regularly reported problems, impacting more than half the survey respondents, underscoring the immediate need for direct interventions in these areas.(1, 5)

    The DEVINE study findings highlight the crucial significance of culturally appropriate valuation tools in guidling national health policy. Many Indian health economic assessments till now have relied on value sets created in high-income countries, which often fail to address India’s distinct cultural, social, and healthcare realities. The DEVINE value set facilitates researchers and policymakers to perform cost-effectiveness evaluations that relate to the local population values, allowing for more precise prioritization of interventions; particularly in settings with limited or inconsistent access to healthcare resources. Therefore, the ability to guide funds toward the most impactful interventions can substantially enhance population health outcomes.(1, 5)

    Additionally, the newly developed population standards help guiding future health studies, allowing researchers to evaluate disease burden more accurately across different demographics. These instruments establish a basis for a more methodical approach to HTA in India, reinforcing the country’s institutional competence to meticulously assess heath technologies and programs. As HTA becomes increasingly integrated into the policy-making framework, the DEVINE study’s inputs will help facilitate transparent and equitable healthcare and funding decisions that are grounded in Indian realities.(1, 5)

    By creating a vigorous EQ-5D-5L value set and population norms for India, the DEVINE study has enhanced academic knowledge while offering actionable insights for policymakers. It depicts a shift toward valuing the lived experiences of Indian populations in economic assessments and supports the broader vision of attaining Universal Health Coverage by means of informed resource allocation. Essentially, DEVINE provides India with the measurements required to enhance healthcare delivery, ensuring highest possible value with health gains against every rupee spent.

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    References

    1. Jyani G, Sharma A, Prinja S, et al. Development of an EQ-5D Value Set for India Using an Extended Design (DEVINE) Study: The Indian 5-Level Version EQ-5D Value Set. Value Health. 2022; 25(7):1218-1226.
    2. Downey LE, Mehndiratta A, Grover A, et al. Institutionalising health technology assessment: establishing the medical technology assessment board in India. BMJ Glob Health. 2017; 2:e000259.
    3. Devlin N, Parkin D, Janssen B. Methods for Analysing and Reporting EQ-5D Data [Internet]. Cham (CH): Springer; 2020. Chapter 1, An Introduction to EQ-5D Instruments and Their Applications. 2020 Jul 21. [Accessed online on 25th June]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK565680/doi: 10.1007/978-3-030-47622-9_1
    4. EQ-5D-5L. EUROQOL. [Accessed online on 25th June]. Available from: https://euroqol.org/information-and-support/euroqol-instruments/eq-5d-5l/
    5. Jyani G, Prinja S, Kar SS, et al. Valuing health-­ related quality of life among the Indian population: a protocol for the Development of an EQ-­ 5D Value set for India using an Extended design (DEVINE) Study. BMJ Open 2020; 10:e039517.

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  • Economic Impact of Climate Change on Health Systems

    Economic Impact of Climate Change on Health Systems

    Economic Impact of Climate Change on Health Systems

    Climate change is rapidly becoming one of the most significant economic threats to global health systems, altering both the scale and nature of health challenges and related costs to address them. As global temperatures rise and extreme weather events become more common, health systems face overwhelming service demand, a wider occurrence of climate-sensitive diseases, and mounting expenses from both acute and chronic conditions. The staggering projections indicate that by 2050, climate change is expected to cause $12.5 trillion in economic losses, imposing an additional $1.1 trillion burden on healthcare systems worldwide, predominantly due to floods, droughts, and heatwaves.(1)

    These climate-associated challenges indicate quantifiable health burdens that impact economic systems at every level. Heat stress, respiratory diseases from air pollution, and the infectious diseases like malaria, dengue, and chikungunya cause increased hospitalizations, rising emergency care and pharmaceutical demands.(2) But the financial costs surpass medical bills through productivity loss, lowered labour capacity, and impaired educational outcomes; all of which collectively hamper economic potential, destabilize public health financing and threaten long-term development.(3) The annual health cost of climate-related impacts in the US alone already exceeds $1 trillion, which continues to rise with each escalating climate event.(4)

    The economic impact of climate change is unjustifiably endured by vulnerable and marginalized populations. Low-income populations, the elderly, children, and people with chronic conditions or limited access to healthcare are most affected by climate hazards. They often live in high-risk areas, lack resources to adjust, and suffer more severe health consequences. These differences intensify existing health disparities, resulting in feedback loops where poor health boosts poverty, which further restricts access to care. The cost of managing preventable diseases in these populations increases public expenditure, further burdening national budgets and healthcare infrastructure.(4-6)

    Health systems are basically under mounting operational and financial pressure. Extreme weather changes can physically impact hospitals, clinics, and supply chains, disturbing service delivery and necessitating expensive repairs. During such catastrophes, elective and preventive care is often delayed, causing loss of revenue and requiring higher costs in the long run.(6, 7) Moreover, the regulatory landscape is getting stricter around emissions and sustainability, demanding health systems to invest in decarbonization approaches, resilient infrastructure, and sustainable procurement. However, these investments can save money in the long run; for instance, early actions by hospitals can lower expenditures on utilities, pay lower insurance, thus retaining their staff for longer.(4, 8)

    Climate change also amplifies threat for health governance and policy. It obscures healthcare planning by causing uncertainty and compelling systems to operate reactively rather than proactively. Disease outbreaks in previously unaffected areas warrant rapid scaling of diagnostics, surveillance, and treatment services, all of which demand swift funding and coordination. The mental health impacts of climate events, including anxiety, trauma, and prolonged psychological distress add to the existing complexities. These challenges are often underestimated, despite their crucial role in long-term health system burden and economic loss.(6, 7, 9)

    Despite the urgency, global health adaptation attempts are persistently underfunded. The United Nations reckons that around $29.4 billion annually will be needed by 2050 for climate-related health adaptation, yet less than 5% of total climate-related development attempts are actually directed at health. Even in such a small share, very few projects are directly supporting health resilience. Disintegrated funding flows and siloed approaches to health and climate financing hamper progress and innovation. Harmonized, cross-sector investment is immediately required to develop robust systems capable of enduring climate shocks and protecting populations equitably.(4, 8, 10)

    Finally, the economic impact of climate change on health systems is not only about rising costs, it also represents a great challenge to the sustainability, equity, and strength of global healthcare. Without quick and transformative action, these systems risk becoming overpowered by the demands of a climate-changed world. Investing in climate-smart health solutions, such as integrated policies, infrastructure advancements, and inclusive care models, can yield huge returns by lowering long-term costs, enhancing outcomes, and protecting societal well-being.

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    References

    1. Eitelwein O, Fricker R, Green A, et al. Quantifying the impact of climate change on human health. World Economic Forum. January 2024. [Accessed online on 20th June 2025]. Available at: https://www3.weforum.org/docs/WEF_Quantifying_the_Impact_of_Climate_Change_on_Human_Health_2024.pdf
    2. Liao H, Lyon CJ, Ying B, Hu T. Climate change, its impact on emerging infectious diseases and new technologies to combat the challenge. Emerg Microbes Infect. 2024 Dec;13(1):2356143.
    3. Helo Sarmiento J, Melo O, Ortiz-Alvarado L, et al. Economic impacts associated with the health effects of climate change in South America: a scoping review. Lancet Reg Health Am. 2023 Sep 27;26:100606.
    4. Building resilient health systems: adapting to climate change. November 2024. [Accessed online on 20th June 2025]. Available at: https://impact.economist.com/sustainability/resilience-and-adaptation/building-resilient-health-systems-adapting-to-climate-change
    5. United States Environmental Protection Agency. Climate Change and the Health of Socially Vulnerable People. [Accessed online on 20th June 2025]. Available at: https://www.epa.gov/climateimpacts/climate-change-and-health-socially-vulnerable-people
    6. Seervai S, Gustafsson L, Abrams MK. The Impact of Climate Change on Our Health and Health Systems. May 2022. [Accessed online on 20th June 2025]. Available at: https://www.commonwealthfund.org/publications/explainer/2022/may/impact-climate-change-our-health-and-health-systems
    7. Rocha J,Oliveira S, Viana CM, Ribeiro AI. Chapter 8 – Climate change and its impacts on health, environment and economy. One Health – Integrated Approach to 21st Century Challenges to Health. 2022; 253-279.
    8. Sulistiadi W, Wasir R, Thalib W, et al. Building health systems resilience: understanding the social, economic, and cultural impacts of climate change from stakeholders’ perspectives in Indonesia. Arch Public Health. 2024; 82:168.
    9. Prosceviciute R, Telesiene A. Climate change and public health: Governance approaches and challenges in Lithuania. Sustainable Futures. 2025; 9:100627.
    10. WHO. Climate Change and Health. Component 10: Sustainable climate and health financing. [Accessed online on 20th June 2025]. Available at: https://www.who.int/teams/environment-climate-change-and-health/climate-change-and-health/country-support/building-climate-resilient-health-systems/climate-and-health-financing

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