A systematic review of school-based interventions to promote digital resilience in children.

The methods of health economic evaluation (HEE), i.e., the comparative analysis of health interventions in terms of costs and consequences [see ], are constantly developing. Accordingly, also HEE reporting standards are expanding or newly evolving to raise awareness about blind spots of previous studies and to guide new ones to account for the methodological developments in a transparent manner. For example, in recent years, besides efficiency, also concerns about prioritizing the more severely ill or about reducing social inequality in health have received increased attention in HEE [see e.g. ]. As a consequence, the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) [, ] was extended to include an item (CHEERS item #19) that requires characterizing distributional effects []. Or, new methods like expert elicitation for generating parameter distributions or value of information analysis for estimating the potential benefit of additional evidence were introduced for HEE, and consequently, reporting standards for using expert judgment [] or estimating value of information [] were developed. A methodological topic that has received substantial interest recently is how to incorporate negative environmental external effects into HEE. One of them is global warming: The healthcare sector emits 4.4% of global greenhouse gases (GHG) and is thus one major contributor to climate change [], with more than two-thirds of these emissions originating from the supply chain (so-called scope three emissions [, ]). Governments have committed to reducing GHG emissions from their health systems, exemplified by initiatives like the Alliance for Transformative Action and Health, aiming for low or net-zero emissions in the health sector [, ]. From April 2028, National Health Service (NHS) suppliers will need to report the GHG emissions of their products to support the reduction of scope 3 emissions in the NHS []. Also, incorporating the external costs of GHG emissions into budget decision-making is becoming mandatory for many public bodies (e.g., in Germany, [, ]). A survey of health technology assessment agencies by Bobini and Cicchetti [] revealed that most of the agencies have either made attempts to or are now working on integrating environmental effects into their evaluation processes. There are a number of recent conceptual studies that provide insights into how environmental impacts can be integrated in HEE as outcomes or as costs theoretically [–] or practically [–]. As the global impact of climate change is directly affecting human health, it could also be argued that it is critical no longer consider the impact of GHG emissions as an externality. Various recent systematic and scoping reviews have explored methods to incorporate environmental impacts into HEE [–], with partly overlapping articles. In their systematic review, Williams, Bell [] report ten different approaches to incorporate environmental impacts into HEE or health technology assessments. These range from integrated approaches such as incorporating environmental impacts as costs [, , , , –] or outcomes [, , ], to separate approaches that use the Incremental Carbon Footprint Effectiveness Ratio (ICFER) [] or Incremental Carbon Footprint Cost Ratio []. Also, they can be integrated using multi-criteria decision analyses [, , , ], evaluated separately alongside HEE [, , , ], reported without further evaluation (information conduit) [] and/or be included in deliberative decision-making processes [, –]. Different health economic study types were identified that provide examples of how external costs of climate change can be incorporated: Budget impact analyses [, ], cost of illness analyses [, ], and health economic evaluations [, ]. Among various aspects that require further work to facilitate systematic incorporation of external environmental costs into HEE, one is methodological standardization [], Guirado-Fuentes, Abt-Sacks [], Pinho-Gomes, Yoo [], also to prevent potential greenwashing []. One possible solution, as Carrandi, Nguyen [] emphasize, is the development of guidelines for reporting environmental impacts in HEEs.