Presentation (CTI)

OBJECTIVES: Current health technology assessment (HTA) frameworks primarily focus on clinical outcomes, patient-reported outcomes, and economic value. While broader social impacts across the healthcare value chain are increasingly acknowledged, they are not yet consistently integrated with other sustainability dimensions and there is limited consensus on how to define and operationalize broader social sustainability within HTA. This study aimed to develop and validate a comprehensive set of social sustainability indicators to support the integration of societal value dimensions into HTA and sustainable healthcare decision-making.
METHODS: A systematic literature review was conducted in Scopus and Web of Science up to April 2025. Identified indicators were structured across social impact categories, stakeholder groups, and healthcare value chain stages. A structured selection process was applied, including materiality assessment and multi-criteria scoring. A Delphi study with experts from academia, healthcare, industry, health economics, and policy was conducted to validate the indicator set and refine associated metrics.
RESULTS: The review identified 3,590 records, of which 37 studies were included, yielding 267 indicators. After materiality screening and structured scoring, 33 indicators were retained as a comprehensive yet feasible set for implementation. The Delphi panel (n=22) showed strongest consensus for indicators aligned with established HTA domains, including health outcomes (DALYs, QALYs), healthcare access, patient experience, healthcare costs, labour conditions, and medicine availability. Lower agreement was observed for more complex or less standardised constructs such as equity, workforce diversity, occupational exposure risks, and antimicrobial resistance-related impacts. The final indicator set spans multiple stakeholder groups and captures impacts across the full healthcare value chain.
CONCLUSIONS: This study provides a validated and operational set of social sustainability indicators that can be integrated into HTA and broader healthcare decision-making sustainability frameworks. By extending assessment beyond traditional value dimensions, the proposed set supports a more comprehensive consideration of societal impact in reimbursement, coverage, and policy decisions.