INCORPORATING ENVIRONMENTAL IMPACT INTO HEALTH TECHNOLOGY ASSESSMENT: A CASE STUDY IN INHALERS
Author(s)
Adam J. Raymakers, BSc, MSc, PhD1, Aaron Kesselheim2, William Feldman, MD, DPhil, MPH3;
1Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School & Brigham and Women's, Research fellow, Boston, MA, USA, 2Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School & Brigham and Women's, USA, 3David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
1Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School & Brigham and Women's, Research fellow, Boston, MA, USA, 2Division of Pharmacoepidemiology and Pharmacoeconomics, Harvard Medical School & Brigham and Women's, USA, 3David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
OBJECTIVES: Health technology assessment agencies have recently been considering incorporating climate impact into their assessments and decision-making processes. While there appears to be support for the idea, operationalization remains a challenge. In this analysis, we provide an illustrative case study that could be considered by HTA agencies, using the example of triple therapy inhalers to treat chronic obstructive pulmonary disease (COPD).
METHODS: Two triple-therapy inhalers used to treat COPD were the basis for this case study. Recent evidence suggests that fluticasone-umeclidinium-vilanterol (Trelegy) and budesonide-glycopyrrolate-formoterol (Breztri ) have similar effectiveness and safety profiles. However, evidence also demonstrates a substantive difference in greenhouse gas (GHG) emissions associated with each inhaler. To assess how HTA agencies might use the totality of this evidence, we used a budget impact analysis framework and then estimated the additional cost of associated with GHG. To do so, costs were estimated across all payers for each inhaler and we then estimated how these costs would change accounting for the social cost of carbon (SCC) values published by the United States Environmental Protection Agency.
RESULTS: Total costs associated with fluticasone-umeclidinium-vilanterol and budesonide-glycopyrrolate-formoterolover over the study period were approximately $20.8B and $3.9B, respectively. Of all triple inhaler therapies dispensed, budesonide-glycopyrrolate-formoterol accounted for 19% and fluticasone-umeclidinium-vilanterol 81%. Total GHG emissions associated with budesonide-glycopyrrolate-formoterol were 104,068 metric tons of CO2 equivalents (mtCO2e) compared to fluticasone-umeclidinium-vilanterol at 24,577 mtCO2e, despite the latter being used more. Accounting for the SCC, the additional costs associated with budesonide-glycopyrrolate-formoterol would be $19.8M and $4.7M for fluticasone-umeclidinium-vilanterol.
CONCLUSIONS: This illustrative analysis shows how HTA agencies can incorporate the climate impact of therapies into budget impact analysis using the social costs of GHG. These estimates provide additional context to the broader impact of treatments. Moreover, this broader calculation of costs could be potentially useful for price negotiations and formulary design.
METHODS: Two triple-therapy inhalers used to treat COPD were the basis for this case study. Recent evidence suggests that fluticasone-umeclidinium-vilanterol (Trelegy) and budesonide-glycopyrrolate-formoterol (Breztri ) have similar effectiveness and safety profiles. However, evidence also demonstrates a substantive difference in greenhouse gas (GHG) emissions associated with each inhaler. To assess how HTA agencies might use the totality of this evidence, we used a budget impact analysis framework and then estimated the additional cost of associated with GHG. To do so, costs were estimated across all payers for each inhaler and we then estimated how these costs would change accounting for the social cost of carbon (SCC) values published by the United States Environmental Protection Agency.
RESULTS: Total costs associated with fluticasone-umeclidinium-vilanterol and budesonide-glycopyrrolate-formoterolover over the study period were approximately $20.8B and $3.9B, respectively. Of all triple inhaler therapies dispensed, budesonide-glycopyrrolate-formoterol accounted for 19% and fluticasone-umeclidinium-vilanterol 81%. Total GHG emissions associated with budesonide-glycopyrrolate-formoterol were 104,068 metric tons of CO2 equivalents (mtCO2e) compared to fluticasone-umeclidinium-vilanterol at 24,577 mtCO2e, despite the latter being used more. Accounting for the SCC, the additional costs associated with budesonide-glycopyrrolate-formoterol would be $19.8M and $4.7M for fluticasone-umeclidinium-vilanterol.
CONCLUSIONS: This illustrative analysis shows how HTA agencies can incorporate the climate impact of therapies into budget impact analysis using the social costs of GHG. These estimates provide additional context to the broader impact of treatments. Moreover, this broader calculation of costs could be potentially useful for price negotiations and formulary design.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HTA31
Topic
Health Technology Assessment
Disease
SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)