Broadening the Evidence Base: Incorporating Environmental Considerations Into HTAs
Author(s)
Ahmad Hecham Alani, PharmD1, Mackenzie Mills, PhD1, Lucy Kanya, PhD2, Panos Kanavos, BSc, MSc, PhD3, Hussain Abdulrahman Al-Omar, MSc, PhD4.
1HTA-Hive, London, United Kingdom, 2Department of Health Policy, London School of Economics and Political Science (LSE), London, United Kingdom, 3Department of Health Policy, Medical Technology Research Group (MTRG), London School of Economics and Political Science (LSE), London, United Kingdom, 4Clinical Pharmacy Department, College of Pharmacy,, King Saud University, Riyadh, Saudi Arabia.
1HTA-Hive, London, United Kingdom, 2Department of Health Policy, London School of Economics and Political Science (LSE), London, United Kingdom, 3Department of Health Policy, Medical Technology Research Group (MTRG), London School of Economics and Political Science (LSE), London, United Kingdom, 4Clinical Pharmacy Department, College of Pharmacy,, King Saud University, Riyadh, Saudi Arabia.
Presentation Documents
OBJECTIVES: This systematic review explored how environmental sustainability (ES) metrics, particularly carbon footprint (CF) analyses, are incorporated into HTA and research practices. The aim was to identify methods, examine ES applications, and determine how these approaches can enhance clinical and economic evaluations.
METHODS: A comprehensive literature search across MEDLINE, Scopus, CINAHL Plus, EconLit, and EMBASE was conducted for studies published up to October 2024. Eligible publications integrated ES considerations—especially CF metrics—into HTAs or related analyses. Two reviewers independently screened studies, extracting data on analytical approaches, key findings, and challenges. Thematic analysis synthesised insights, following PRISMA 2020 guidelines.
RESULTS: Seventy-five articles met the inclusion criteria. Life cycle assessment, carbon footprinting, and environmentally extended input-output analysis were the most methods used to quantify greenhouse gas emissions of pharmaceuticals, medical devices, and procedures. The CF of pharmaceuticals showed stark disparities, ranging from 276,596 kg CO2e/kg API (Active Pharmaceutical Ingredient) for nivolumab to just 0.67 kg CO2e/kg API for Paracetamol (produced in India)—a difference exceeding 400,000-fold. CF values varied widely due to differences in production methods, usage patterns, and geographic contexts. Many studies demonstrated that incorporating ES metrics into HTA improved decision-making, sometimes yielding long-term financial and clinical benefits. Recent HTA reports, particularly from PBAC and CDA, often focused on drug wastage to address environmental concerns, reflecting a limited scope. Emerging frameworks suggested pairing clinical outcomes with ES data to guide technology adoption, but the lack of standardised metrics and reporting practices limited cross-study comparability and policy implementation.
CONCLUSIONS: Integrating ES metrics into HTA supports value-based decision-making by revealing opportunities for sustainable innovation and cost efficiencies. To maximise impact, future efforts should target high-emission technologies (e.g., monoclonal antibodies). Advancing integration requires standardised methodologies, robust data collection, and global reporting frameworks, enabling policymakers to address ES alongside clinical and economic objectives.
METHODS: A comprehensive literature search across MEDLINE, Scopus, CINAHL Plus, EconLit, and EMBASE was conducted for studies published up to October 2024. Eligible publications integrated ES considerations—especially CF metrics—into HTAs or related analyses. Two reviewers independently screened studies, extracting data on analytical approaches, key findings, and challenges. Thematic analysis synthesised insights, following PRISMA 2020 guidelines.
RESULTS: Seventy-five articles met the inclusion criteria. Life cycle assessment, carbon footprinting, and environmentally extended input-output analysis were the most methods used to quantify greenhouse gas emissions of pharmaceuticals, medical devices, and procedures. The CF of pharmaceuticals showed stark disparities, ranging from 276,596 kg CO2e/kg API (Active Pharmaceutical Ingredient) for nivolumab to just 0.67 kg CO2e/kg API for Paracetamol (produced in India)—a difference exceeding 400,000-fold. CF values varied widely due to differences in production methods, usage patterns, and geographic contexts. Many studies demonstrated that incorporating ES metrics into HTA improved decision-making, sometimes yielding long-term financial and clinical benefits. Recent HTA reports, particularly from PBAC and CDA, often focused on drug wastage to address environmental concerns, reflecting a limited scope. Emerging frameworks suggested pairing clinical outcomes with ES data to guide technology adoption, but the lack of standardised metrics and reporting practices limited cross-study comparability and policy implementation.
CONCLUSIONS: Integrating ES metrics into HTA supports value-based decision-making by revealing opportunities for sustainable innovation and cost efficiencies. To maximise impact, future efforts should target high-emission technologies (e.g., monoclonal antibodies). Advancing integration requires standardised methodologies, robust data collection, and global reporting frameworks, enabling policymakers to address ES alongside clinical and economic objectives.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HTA23
Topic
Health Technology Assessment
Topic Subcategory
Systems & Structure, Value Frameworks & Dossier Format
Disease
No Additional Disease & Conditions/Specialized Treatment Areas