OBJECTIVES:

In 2010, NHS accounted for ~4% of total national emissions, with pharmaceuticals as the major contributor. The US healthcare system accounts for a significant fraction of the national air pollution emissions, paradoxically accounting for 405,000-470,000 DALYs in 2013. Pharmaceutical production and usage in sites with poor wastewater management have resulted in ecological and human health risks due to high concentrations of active pharmaceutical ingredients within 26% of studied rivers. This systematic review aims at clarifying how health economic evaluation (HEE) and health technology assessment (HTA) can be utilized to mitigate the environmental impact (EI) of health care.

METHODS:

A systematic literature review was conducted within Pubmed, Google Scholar, and the International HTA Database 16^thJune2022 to identify papers assessing or discussing EI along with HEE or HTA. The review followed PRISMA 2020. Data extraction included which environmental impact category was assessed in accordance with the EN15804(A1+A2) standard for life cycle assessment (LCA), study type and suggested implementation of EI into HEE or HTA.

RESULTS:

289 records were initially for screening. Nine articles were included. Six articles assessed environmental impact of interventions, of these three assessed the CO2 equivalent, two assessed the eco-toxicity of freshwater and one conducted a full LCA. Three papers presented perspectives to consider regarding the implementation of environmental impact into HEE and HTA.

CONCLUSIONS:

Even though the EI of healthcare is significant, only 9 identified papers addressed EI together with HEE or HTA. To integrate EI into HTA, method development is needed. Methods could include implementation of EI as an independent category in HTA; or potentially an updated HEE method, including EI health-effects, adoption of uniform EI measures, or adding an environmental cost indicator. There is a clear need of further evidence and methods development on EI trade-off and WTP to implement EI in HTA along with more EI+HEE feasibility studies.