OBJECTIVES: Globally it is estimated that healthcare accounts for between 1% and 5% of the global greenhouse gases and air pollutants. First, this study investigated the current polices, action plans, and metrics being used by healthcare toward the reduction of their environmental impact. Second, this study investigated the utility of these metrics within economic evaluations.

METHODS: A landscaping review was conducted to investigate published policies, action plans, and metrics being deployed by national healthcare systems and health technology assessment bodies. Based on the metrics used to define environmental impact identified through the landscaping review, the feasibility of including these outcomes into health economic analyses was explored.

RESULTS: Based on the identified healthcare policies, NHS England was the first healthcare system to pledge net zero carbon emissions across healthcare services, through deploying polices such as delivering care at home to reduce patient journeys to hospitals. Across the G20 countries, several environmental goals focused on the reduction of emissions have been set, each nation setting their own internal goals across all aspects of their policy landscape. These include policies such as low carbon prescribing, considering supply chain impact emissions, geographical sourcing and favouring low CO2 packaging.

CONCLUSIONS: Carbon emissions were a key metric used to quantify the effect of government policies on the environment across several healthcare systems and could be considered within economic analysis. Other metrics were also considered within the healthcare system when assessing environmental impact, however these are less universal in use and may provide less benefit to economic evaluations. Overall, the impact of healthcare on the environment is becoming an increasingly important issue globally, and therefore the need to be able to quantify this through economic evaluations is critical, which may be achieved through the inclusion of the CO2 emission impact alongside the budget impact of treatments.