Presentation (CTI)

OBJECTIVES: Environmental sustainability in healthcare is becoming increasingly important, with several countries committing to climate-neutral systems by 2050 under COP26. However, no standardized framework currently exists to assess and combine environmental sustainability outcomes alongside economic and social dimensions in health technology assessments (HTAs). This research aims to provide a comprehensive overview of existing multi-dimension integration methods and evaluate their applicability within HTA. It also applies a subset of available methods to an inhaler case, comparing metered-dose inhalers (MDIs) to dry powder inhalers (DPIs), exploring how methodological choices influence the assessment of sustainability trade-offs and decision-making. This provides insights into the benefits and limitations of selected methods, supporting more sustainable HTA practices aligned with long-term public health and sustainability goals.
METHODS: A scoping review was conducted using PubMed and Embase, including systematic and scoping reviews published within the last five years. The review adopted a broad perspective, encompassing literature beyond the HTA field to identify a wide range of integration methods. These were categorized and assessed for their relevance to environmental HTA. Methods for case study application were selected to represent commonly applied and methodologically distinct approaches for integration. For the case study, data on social, economic and environmental indicators were retrieved from secondary literature sources.
RESULTS: The scoping review identified 5,467 records, of which 43 articles underwent full-text screening. In total, 55 integration methods were identified and categorized (e.g. distance to optimal point, weighting, monetization, normalization), demonstrating methodological heterogeneity. Seven methods (AHP, LCSA, TOPSIS, MAVT, EVIDEM, DEA and SROI) were selected and applied to the inhaler case.
CONCLUSIONS: A range of methods exists to integrate social, economic, and environmental dimensions, but their application in HTA remains limited. Future research should emphasize stakeholder-informed method selection and the development of practical guidance to facilitate the routine integration of sustainability considerations into HTA.