Carmen Guirado

Health technology assessment (HTA) provides evidence-based information on healthcare technology to support decision making in many countries. Environmental impact is a relevant dimension of a health technology’s value, but it has been poorly addressed in HTA processes in spite of the commitment that the health sector must have to contribute to mitigating the effects of climate change. This study aims to identify the state of the art and challenges for quantifying environmental impacts that could be incorporated into the economic evaluation (EE) of HTA. We performed a scoping review that included 22 articles grouped into four types of contribution: (1) concepts to draw up a theoretical framework, (2) HTA reports, (3) parameter designs or suitable indicators, and (4) economic or budgetary impact assessments. This review shows that evaluation of the environmental impact of HTAs is still very incipient. Small steps are being taken in EE, such as carbon footprint estimations from a life-cycle approach of technologies and the entire care pathway.

All EU countries have introduced Human papilloma virus (HPV) vaccination for adolescent girls and many countries are expanding the strategy to include adolescent boys. There is uncertainty about the cost-effectiveness and epidemiological impact of a gender-neutral HPV vaccination strategy. Here we present the results of an economic model adapted for Spain. Five vaccination strategies were compared from the Spanish healthcare system perspective, combining two vaccines (4-valent and 9-valent) in a gender-neutral or girls-only programme in a dynamic population-based model with a discrete-time Markov approach. Costs and benefits were discounted at 3%. The benefits of immunization were measured with quality-adjusted life years (QALYs), which are achieved by reducing the incidence of diseases attributable to HPV. Incremental cost-effectiveness ratio (ICER) was compared with the willingness-to-pay threshold in Spain. The two most effective strategies were compared: gender-neutral 9-valent vaccination vs. girls-only 9-valent vaccination, resulting in an ICER of € 34,040/QALY, and an important number of prevented cases of invasive cancers and anogenital warts. The sensitivity analysis revealed that gender-neutral 9-valent vaccination would become cost-effective if protection against oropharyngeal and penile cancers was included or if the price per dose decreased from €45 to €28. The gender-neutral 9-valent HPV vaccination in Spain offers more benefits than any other modeled strategy, although in the conservative base case it is not cost-effective. However, certain plausible assumptions would turn it into an efficient strategy, which should be borne in mind by the decision makers together with equity and justice arguments. What is the context? What this study adds? What is the impact?

We present two years of in situ measurements of water vapour (H₂O) and its isotopologue ratio (δD, the standardized ratio between H₂¹⁶O and HD¹⁶O), made at two remote mountain sites on Tenerife in the subtropical North Atlantic. We show that the data – if measured during night-time – are well representative for the lower/middle free troposphere. We use the measured H₂O-δD pairs, together with dust measurements and back trajectory modelling for analysing the moisture pathways to this region. We can identify four principally different transport pathways. The air mass transport from high altitudes and high latitudes shows two different scenarios. The first scenario brings dry air masses to the stations, as the result of condensation events occurring at low temperatures. The second scenario brings humid air masses to the stations, due to cross-isentropic mixing with lower-level and more humid air during transport since last condensation (LC). The third pathway is transportation from lower latitudes and lower altitudes, whereby we can identify rain re-evaporation as an occasional source of moisture. The fourth pathway is linked to the African continent, where during summer, dry convection processes over the Sahara very effectively inject humidity from the boundary layer to higher altitudes. This so-called Saharan Air Layer (SAL) is then advected westward over the Atlantic and contributes to moisten the free troposphere. We demonstrate that the different pathways leave distinct fingerprints on the measured H₂O-δD pairs.

This paper presents the reconstruction of a 73-year time series of the aerosol optical depth (AOD) at 500 nm at the subtropical high-mountain Izaña Atmospheric Observatory (IZO) located in Tenerife (Canary Islands, Spain). For this purpose, we have combined AOD estimates from artificial neural networks (ANNs) from 1941 to 2001 and AOD measurements directly obtained with a Precision Filter Radiometer (PFR) between 2003 and 2013. The analysis is limited to summer months (July–August–September), when the largest aerosol load is observed at IZO (Saharan mineral dust particles). The ANN AOD time series has been comprehensively validated against coincident AOD measurements performed with a solar spectrometer Mark-I (1984–2009) and AERONET (AErosol RObotic NETwork) CIMEL photometers (2004–2009) at IZO, obtaining a rather good agreement on a daily basis: Pearson coefficient, R, of 0.97 between AERONET and ANN AOD, and 0.93 between Mark-I and ANN AOD estimates. In addition, we have analysed the long-term consistency between ANN AOD time series and long-term meteorological records identifying Saharan mineral dust events at IZO (synoptical observations and local wind records). Both analyses provide consistent results, with correlations > 85 %. Therefore, we can conclude that the reconstructed AOD time series captures well the AOD variations and dust-laden Saharan air mass outbreaks on short-term and long-term timescales and, thus, it is suitable to be used in climate analysis.

We present two years of measurements of water vapour (H2O) and its isotopologue ratio (δD, the standardized ratio between H216O and HD16O) made at two remote mountain sites on Tenerife Island in the subtropical North Atlantic. We show that the data – if measured during nighttime – are well representative for the lower/middle free troposphere. We use the measured H2O-δD pairs, together with dust measurements and back-trajectory modelling for analysing the moisture pathways to this region. We can identify four principally different transport pathways. The first two pathways are linked to transport from high altitudes and high latitudes, whereby the respective air can be dry, due to last condensation occurring at low temperatures, as well as humid, due to cross isentropic mixing with lower level and more humid air during transport since last condensation. The third pathway is transport from lower latitudes and lower altitudes, whereby we can identify rain re-evaporation as an occasional source of moisture. The fourth pathway is linked to the African continent, where during summer dry convection processes over the Sahara very effectively inject humidity from the boundary layer to higher altitudes. This so-called Saharan Air Layer (SAL) is then advected westward over the Atlantic and contributes to moisten the free troposphere. We demonstrate that different pathways leave distinct fingerprints on the measured H2O-δD pairs.

This paper presents the reconstruction of the 73 year time series of the aerosol optical depth (AOD) at 500 nm at the subtropical high-mountain Izaña Atmospheric Observatory (IZO) located in Tenerife (Canary Islands, Spain). For this purpose, we have combined AOD estimates from artificial neural networks (ANNs) from 1941 to 2001 and AOD measurements directly obtained with a Precision Filter Radiometer (PFR) between 2003 and 2013. The analysis is limited to summer months (July–August–September), when the largest aerosol load is observed at IZO (Saharan mineral dust particles). The ANN AOD time series has been comprehensively validated against coincident AOD measurements performed with a solar spectrometer Mark-I (1984–2009) and AERONET (AErosol RObotic NETwork) CIMEL photometers (2004–2009) at IZO, obtaining a rather good agreement on a daily basis: Pearson coefficient, R, of 0.97 between AERONET and ANN AOD, and 0.93 between Mark-I and ANN AOD estimates. In addition, we have analyzed the long-term consistency between ANN AOD time series and long-term meteorological records identifying Saharan mineral dust events at IZO (synoptical observations and local wind records). Both analyses provide consistent results, with correlations larger than 85 %. Therefore, we can conclude the reconstructed AOD time series captures well the AOD variations and dust-laden Saharan air mass outbreaks at short-term and long-term time scales and, thus, it is suitable to be used in climate analysis.

The project MUSICA (MUlti-platform remote Sensing of Isotopologues for investigating the Cycle of Atmospheric water) integrates tropospheric water vapour isotopologue remote sensing and in situ observations. This paper presents a first empirical validation of MUSICA's H₂O and δD remote sensing products, generated from ground-based FTIR (Fourier transform infrared), spectrometer and space-based IASI (infrared atmospheric sounding interferometer) observation. The study is made in the area of the Canary Islands in the subtropical northern Atlantic. As reference we use well calibrated in situ measurements made aboard an aircraft (between 200 and 6800 m a.s.l.) by the dedicated ISOWAT instrument and on the island of Tenerife at two different altitudes (at Izaña, 2370 m a.s.l., and at Teide, 3550 m a.s.l.) by two commercial Picarro L2120-i water isotopologue analysers. The comparison to the ISOWAT profile measurements shows that the remote sensors can well capture the variations in the water vapour isotopologues, and the scatter with respect to the in situ references suggests a δD random uncertainty for the FTIR product of much better than 45‰ in the lower troposphere and of about 15‰ for the middle troposphere. For the middle tropospheric IASI δD product the study suggests a respective uncertainty of about 15‰. In both remote sensing data sets we find a positive δD bias of 30–70‰. Complementing H₂O observations with δD data allows moisture transport studies that are not possible with H₂O observations alone. We are able to qualitatively demonstrate the added value of the MUSICA δD remote sensing data. We document that the δD–H₂O curves obtained from the different in situ and remote sensing data sets (ISOWAT, Picarro at Izaña and Teide, FTIR, and IASI) consistently identify two different moisture transport pathways to the subtropical north eastern Atlantic free troposphere.