Incorporating Environmental Impacts Into Budget Impact Models: A Case Study of CAR-T Therapies in France

Author(s)

José Fernandes Soares, MSc, Erwan Autin, MSc, Mario Pozzar, MSc, Anne-Line Couillerot, MSc.
Alira Health, Paris, France.
OBJECTIVES: Explore and illustrate how environmental impacts can be identified, quantified, and integrated into budget impact models (BIMs), regarding recent French policy developments (including Haute Autorité de Santé 2022-2024 health environment roadmap and 2024 Social Security Financing Bill). We conducted a case study comparing CAR-T therapy with conventional chemotherapy in the French healthcare context.
METHODS: A targeted literature review was conducted to identify key frameworks for integrating environmental impacts into health technology assessments (NICE typology, Williams et al. (2023), ECOVAMED). A BIM was adapted to incorporate patient transport-related emissions, using official data on travel patterns and standard carbon intensity factors. Emissions were expressed in kgCO₂-equivalent and valued using the official national carbon price (€83.56/ton).
RESULTS: Carbon footprint was the most common environmental metric used in the literature, often derived through life cycle assessment. Thus, environmental impact was integrated via transport-related carbon emissions in the case study. This information was also easily available compared to other impacts (e.g., Hospitalization-related emissions in France). CAR-T therapy requires fewer patient visits (4 round trips, average distance for chemotherapy in France: 25 km/journey, i.e., 400 km total) compared to chemotherapy (13 round trips, 650 km total annually). Transport-related carbon emissions for CAR-T were estimated at 76,000kgCO₂e versus 123,500kgCO₂e for chemotherapy, translating into €6,351 and €10,320 in environmental costs, respectively. Including caregiver travel added further differentiation (19,000kgCO₂e, €1,588).
CONCLUSIONS: Incorporating environmental externalities altered the net budget impact and highlighted organizational and societal costs not captured in standard models. It can influence health-economic outcomes and decision-making. This approach should extend to other life cycle stages (e.g., production, distribution, disposal) to derive relevant information. Broader integration into BIMs could support more sustainable health decision-making, especially as French institutions are reflecting to move toward environmental inclusion in HTA and pricing. Standardized guidance will be essential to ensure comparability and avoid methodological variability.

Conference/Value in Health Info

2025-11, ISPOR Europe 2025, Glasgow, Scotland

Value in Health, Volume 28, Issue S2

Code

P35

Topic

Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research

Topic Subcategory

Budget Impact Analysis, Novel & Social Elements of Value

Disease

Oncology, Personalized & Precision Medicine

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