Presentation (CTI)

OBJECTIVES: Consideration of the environment in HTA is increasingly proposed, given the major contribution of medicines and other technologies to the environmental impact of healthcare. We sought to understand in which situations this could become relevant in the future, as a flag to technology developers for R&D and evidence planning.
METHODS: We assessed the scope of environmental considerations proposed by HTA agencies, through a review of current guidance and policy documents as of May 2025. We further searched literature on environment / HTA to identify prominent scenarios and specific environmental factors impacted.
RESULTS: Incorporation of environmental considerations into decision-making was identified in national agency policies in seven countries, though at differing stages of development and implementation. Environmental factors considered were described broadly (including climate change, pollution/waste, resource consumption, and biodiversity) or not specified in most markets; carbon dioxide emissions and pharmaceutical wastewater were specified by two and one agencies, respectively. Within literature, reviews identified disposable medical devices and greenhouse gases from propellants and anesthetics as the most prominent examples where environmental considerations were discussed in previous HTAs. However, wider literature has tested application of environmental impact indicators to a disparate range of technologies, and to healthcare delivery more broadly. Among records of published life cycle analyses, analgesics, anesthesia and respiratory inhalers were the most common pharmaceutical agents studied. Examples of specific associations between technology and environmental damage are cited in literature, but no systematic assessment across technologies was identified.
CONCLUSIONS: As likely unrealistic to incorporate environmental aspects in every assessment, it will be important to understand what environmental impact and associated technologies would be considered in HTA - potentially driven by magnitude of impact or assessment feasibility. This review identified an emerging but uncertain picture, to await specification and prioritization by agencies supported by further research.