Advancing a Greener Ecosystem in Health Technology Assessment: A Review of Environmental Integration as an Additional Value Driver
Author(s)
Ipek Ozer Stillman, MBA, MSc1, Lilia Leisle, BS, MSc, PhD2, Jeffrey M Muir, MSc3, Grammati Sarri, MSc, PhD4.
1Takeda, Cambridge, MA, USA, 2Cytel, Berlin, Germany, 3Cytel, Toronto, ON, Canada, 4Cytel, London, United Kingdom.
1Takeda, Cambridge, MA, USA, 2Cytel, Berlin, Germany, 3Cytel, Toronto, ON, Canada, 4Cytel, London, United Kingdom.
OBJECTIVES: The healthcare industry accounts for 5% of global carbon dioxide emissions and would be the fifth largest carbon emitter worldwide, were it a country. As such, incorporating environmental considerations into health technology assessments (HTA) as an additional value driver is an emerging topic. This review aimed to identify how environmental and sustainability factors are currently considered in HTA.
METHODS: Embase and MEDLINE databases were searched in March 2025 for publications dating to 2014. Publicly accessible full texts or conference proceedings providing context on environmental impact (EI) and sustainability integration into HTA were included. Screening and extraction were conducted by two reviewers, and qualitative synthesis was used to identify themes and gaps.
RESULTS: Of 1,505 records screened, 48 underwent full-text review, and 22 (10 full-text articles, 12 posters) met inclusion criteria. Studies were grouped in three categories: theoretical frameworks (N=6), general methodological approaches and case studies (N=16), and status quo of select HTA agencies (N=5). EI was commonly assessed as carbon footprint, with limited attention to other environmental spillovers. Frameworks recommended stepwise approaches, with identification and quantification of relevant EIs representing two common steps. Standardized methods for evaluating and monetizing environmental data within HTA remain lacking. Yet, individual case studies exemplified methodological success, e.g., by demonstrating that one diabetes drug offered cost-effective and environmental benefits over another by lowering the incremental cost-effectiveness ratio by 4.1%. However, adoption at the national HTA level is sparse, and actual use of environmental evidence in HTA remains limited.
CONCLUSIONS: Despite the growing interest in sustainability topics in HTA, there is limited real-life experience and guidance on this topic. Clear measurement metrics and new HTA processes such as living HTA may facilitate the incorporation of environmental considerations across the product lifecycle. For truly sustainable healthcare, future HTA must consider broader value elements such as equity and long-term EIs.
METHODS: Embase and MEDLINE databases were searched in March 2025 for publications dating to 2014. Publicly accessible full texts or conference proceedings providing context on environmental impact (EI) and sustainability integration into HTA were included. Screening and extraction were conducted by two reviewers, and qualitative synthesis was used to identify themes and gaps.
RESULTS: Of 1,505 records screened, 48 underwent full-text review, and 22 (10 full-text articles, 12 posters) met inclusion criteria. Studies were grouped in three categories: theoretical frameworks (N=6), general methodological approaches and case studies (N=16), and status quo of select HTA agencies (N=5). EI was commonly assessed as carbon footprint, with limited attention to other environmental spillovers. Frameworks recommended stepwise approaches, with identification and quantification of relevant EIs representing two common steps. Standardized methods for evaluating and monetizing environmental data within HTA remain lacking. Yet, individual case studies exemplified methodological success, e.g., by demonstrating that one diabetes drug offered cost-effective and environmental benefits over another by lowering the incremental cost-effectiveness ratio by 4.1%. However, adoption at the national HTA level is sparse, and actual use of environmental evidence in HTA remains limited.
CONCLUSIONS: Despite the growing interest in sustainability topics in HTA, there is limited real-life experience and guidance on this topic. Clear measurement metrics and new HTA processes such as living HTA may facilitate the incorporation of environmental considerations across the product lifecycle. For truly sustainable healthcare, future HTA must consider broader value elements such as equity and long-term EIs.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HTA25
Topic
Health Technology Assessment
Topic Subcategory
Value Frameworks & Dossier Format
Disease
No Additional Disease & Conditions/Specialized Treatment Areas