Healthcare is a rapidly growing industry as medical treatments become more sophisticated, more in demand due to increasing incidence of chronic disease and more widely available worldwide. This booming industry is also creating more waste than ever before and, as such, there is a growing need to treat and dispose of this waste. Healthcare waste (HCW) disposal includes a multitude of disposal methods, including incineration, landfilling and chemical treatments. These rudimentary methods and their growing use present their own problems that negatively impact both the environment and, in turn, damage public health, thus contributing to a global healthcare crisis. The aim of this review was to examine the current HCW disposal methods in place and the harmful effects they have on the environment and on public health. The findings accumulated in this review demonstrate a heavy reliance on basic, low tech HCW disposal techniques and uncovered the negative impacts of these methods. There is a notable lack of employment of “greener” HCW disposal methods on a largescale due to cost, access and feasibility. Despite innovations in HCW disposal, there is no scalable, global green solution at present. Further, the review highlights that global health consequences of HCW disposal methods often differ depending on how developed the country is.

The ECHO (Extensions Community Healthcare Outcomes) model of healthcare delivery has grown rapidly since its establishment and increased in popularity in recent years. This expansion has developed alongside the growing incidence of chronic diseases and the need to better manage them. The increasing uptake in ECHO has presented a requirement to assess its true value as healthcare costs are increasing globally, resulting in a growing demand by governments and policy makers to ensure chronic disease management strategies provide true value. Therefore, the aim of this review is to examine the impact that ECHO has on clinical practice and how such impacts are measured or evaluated. A narrative literature review is carried out to examine the outcomes assessed in ECHO-related studies. Three key academic databases were utilised for the literature search: Web of Science, PubMed, and Medline. Keywords relating to the review were chosen and searched for. Papers were screened using specified inclusion and exclusion criteria relating to years of publication (2000–2020), type of publication (original research, review papers and meta-analyses) and language requirements (English language only). This review found that while the ECHO model is expanding, and improving the so-called “knowledge gap” between specialists and primary care physicians, there is also a gap in the ways value is examined within ECHO. Most studies on ECHO lack an examination of patient reported health outcomes and appropriate, comparative costing methods. Current ECHO-related studies lack vital components that demonstrate the value of the model. Such components include patient reported health outcomes and detailed costing comparisons between the ECHO model and the traditional care pathway it is replacing.

Chronic diseases are at epidemic proportions and continuing to increase in both incidence and prevalence globally. Therefore, there is a growing need to assess and improve on the value currently provided within chronic care pathways. Examining the costs associated with care pathways is a critical part of assessing this value in order to better understand and introduce potential cost-saving interventions. Examining one such chronic disease, Rheumatoid Arthritis (RA), this study aimed to assess the cost associated with RA in primary care within the Health Service Executive (HSE) in Ireland. Following mapping of the care pathway, patient vignettes based on exemplar RA patient types were used to conduct semi-structed interviews with every member (N = 21) of the primary care RA pathway. Time-Driven Activity-Based Costing (TDABC) was then used to calculate the overall cost of each patient (vignette) type. RA is an expensive condition regardless of disease stage. However, newly diagnosed patients as well as those with advanced disease in need of surgical interventions demonstrated the highest costs in terms of primary care personnel use. Additionally, patients prescribed Biological Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) cost significantly more than those on Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs (csDMARDs) regardless of disease stage or personnel resource use. RA and a subset of RA patients that exert the highest healthcare costs are growing in prevalence. Therefore, this study contributes by assessing the costs associated with RA in HSE primary care that can facilitate better understanding the current value being provided and improve upon the current care pathway to cut future costs.