A Targeted Literature Review Into Incorporating Environmental Impact of Healthcare Into Health Technology Assessments (HTAS)

OBJECTIVES: Several countries have stated initial goals for incorporating environmental factors into their Health Technology Assessment (HTA), with NICE in the United Kingdom aiming to do so as early as 2026. This research aims to broaden the understanding of value of new treatments, with a focus on environmental impact from a health economics perspective.

METHODS: A targeted literature review was conducted to identify evidence dating from January 2012 to March 2022 on the impact of environmental sustainability measures in current and future HTA decisions. Key focus areas of this research included HTA, environmental impact, sustainability, healthcare, and environment.

RESULTS: The literature search identified 14 relevant documents of which 7 publications held sufficient details that were included. All the publications measured environmental impact through carbon emissions. Studies included chronic diseases like diabetes, psychiatry, and asthma that adapted clinical-economic models to include environmental outcomes to predict outcomes of different health interventions. Modelling methods examined trade-offs between disposable and reusable inhaler materials, differential carbon emissions via different treatment regimens to simulate disease outcomes for treatment duration to quantify environmental impact across the healthcare supply chain. While all the publications made sustainability claims through the reduction of carbon emissions, 4 (57%) studies quantified the cost of carbon emissions through health economic modelling.

CONCLUSIONS: This research found carbon emissions as a key indicator to estimate environmental impact for different health interventions. Improvements in environmental impact can add value to treatments and be a differentiator between key comparators. While HTA methods are well-developed for clinical and economic evaluation, environmental impacts do not have the same high-quality sources of data or assessment methods. HTA bodies are currently exploring ways to incorporate environmental impact into their assessment processes. Health economists should start planning now for future HTA submissions that include potential evidence on environmental impact.