OBJECTIVES:

The global environmental impact of healthcare is high. National governments have implemented measures to reduce emissions in the healthcare sector, including the NHS in the UK, as outlined in its Long-Term Plan, 2019. When assessing new technologies, health care decision makers have the opportunity to examine their environmental impact during Health Technology Assessment (HTA). This study assessed if environmental impacts were included in HTA frameworks or guidance from a selection of HTA agencies and whether it influenced decision-making.

METHODS:

We searched HTA agency websites (www.pbs.gov.au [Australia], www.cadth.ca [Canada], www.nice.org.uk [England], www.zorginstituutnederland.nl/ [Netherlands], www.scottishmedicines.org.uk [Scotland], www.tlv.se [Sweden]) to identify reference to environmental impact/carbon footprint in their frameworks or guidance.

RESULTS:

No current guidance or frameworks were identified for NICE; however, a framework for 2026 is in development for quantifying environmental sustainability. NICE published a Patient Decision Aid on asthma inhalers in 2019, highlighting carbon footprint as a factor in inhaler choice. TLV published guidance on a trial regarding the introduction of an environmental premium in the pharmaceutical benefits system for 2024–2027. This voluntary trial is applied only to drug groups including sex hormones, antibiotics, and anti-inflammatory and analgesic drugs. Like NICE, ZIN implemented an initiative to analyse data on the environmental impact of different types in inhaled medication. No information was identified from the CADTH, PBAC, or SMC.

CONCLUSIONS:

No formal inclusion of environmental considerations in HTA were identified. The impact of lung medications has been considered by NICE and ZIN. NICE and TLV are developing frameworks incorporating environmental impacts, suggesting it may be a future criterion. With the importance of environmental impact in healthcare gaining traction, it is feasible that other HTA agencies will follow in developing a framework to include environmental impact in their decision-making process and pharmaceutical companies should prepare for this in future submissions.