INTEGRATING ENVIRONMENTAL EXTERNALITIES INTO ECONOMIC EVALUATION: A CASE STUDY BASED ON A FRENCH HTA ASSESSMENT
Author(s)
Mateo Crec’hriou, MSc1, Nicolas Virely, PharmD1, Romain Supiot, MSc1, Rahma Sellami, PharmD1, Marine Sivignon, PharmD2.
1Inizio Ignite Putnam, Paris, France, 2Inizio Ignite Putnam, Lyon, France.
1Inizio Ignite Putnam, Paris, France, 2Inizio Ignite Putnam, Lyon, France.
OBJECTIVES: A French health technology assessment (HTA) case study was selected, in which an oral treatment was assessed against infusion alternatives to explore whether lower use-phase emissions could be documented alongside economic results. Due to limited incremental efficacy versus selected comparators, the Economic and Public Health Assessment Committee (CEESP) opinion reported an incremental cost-effectiveness ratio (ICER) of over €2.6 million per QALY gained. This limitation of the economic evidence to the cost-effectiveness analysis (CEA) results only, may leave broader value dimensions insufficiently captured. This study therefore assessed how environmental externalities could complement a French HTA-based economic evaluation.
METHODS: Two approaches were considered: carbon monetization and an extended CEA. A model estimated environmental impact, expressed in kilograms of carbon dioxide equivalent (kgCO2e) from oral therapy utilisation versus a mixed infusion comparator arm. Emission factors for logistics, patient transport, and administration/preparation were applied over one year. Carbon monetization assigned a monetary value to avoided emissions, while the extended CEA positioned the environmental impact alongside the ICER.
RESULTS: The oral therapy generated 36.2 kgCO2e per patient-year versus 192.7 kgCO2e for the weighted comparator arm, corresponding to 156.5 kgCO2e avoided per patient-year and an 81.2% reduction. For the target population (270 patients) over one year, this represented 42.3 tonnes of CO2e avoided, corresponding to a monetary valuation of €10,816. The extended CEA showed that the oral therapy was environmentally favorable versus infusion comparators, while a very high ICER would not be considered cost-effective by health authorities.
CONCLUSIONS: In several cases, a CEA alone could not capture the whole benefit of the new technology assessed in HTA. New dimensions such as environmental externalities or organisational impact may capture complementary value, offering an additional perspective alongside HTA-based economic evaluation to help contextualize the value of health technologies.
METHODS: Two approaches were considered: carbon monetization and an extended CEA. A model estimated environmental impact, expressed in kilograms of carbon dioxide equivalent (kgCO2e) from oral therapy utilisation versus a mixed infusion comparator arm. Emission factors for logistics, patient transport, and administration/preparation were applied over one year. Carbon monetization assigned a monetary value to avoided emissions, while the extended CEA positioned the environmental impact alongside the ICER.
RESULTS: The oral therapy generated 36.2 kgCO2e per patient-year versus 192.7 kgCO2e for the weighted comparator arm, corresponding to 156.5 kgCO2e avoided per patient-year and an 81.2% reduction. For the target population (270 patients) over one year, this represented 42.3 tonnes of CO2e avoided, corresponding to a monetary valuation of €10,816. The extended CEA showed that the oral therapy was environmentally favorable versus infusion comparators, while a very high ICER would not be considered cost-effective by health authorities.
CONCLUSIONS: In several cases, a CEA alone could not capture the whole benefit of the new technology assessed in HTA. New dimensions such as environmental externalities or organisational impact may capture complementary value, offering an additional perspective alongside HTA-based economic evaluation to help contextualize the value of health technologies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA312
Topic
Economic Evaluation, Health Technology Assessment
Topic Subcategory
Value Frameworks & Dossier Format
Disease
No Additional Disease & Conditions/Specialized Treatment Areas