OBJECTIVES: Manufacture, distribution, use, excretion, and disposal of health technologies all have environmental impacts. In the new Health Technology assessment (HTA) definition, environmental impact (EI) is recognized as a domain that should be assessed. However, EI in HTA methods are lacking. Aim of this study was to identify current advances and limitations in incorporating EI in HTA evaluation.

METHODS: We conducted an extensive literature review in Embase and MEDLINE, using the following keywords: HTA, environmental impact, and environmental sustainability. No publication date or language restrictions were imposed. Additionally, no filters by study design or type of evaluated technology were used.

RESULTS: Identified publications highlighted the lack of robust and clear methods of EI assessment and its inclusion in HTA process. Several authors have outlined the importance of assessing the EI of health technology throughout its life cycle, including raw material, manufacturing, use, and disposal. However, the EI assessment in HTA present significant challenges, such as determining a clear domain of EI, the perspective, and the time horizon for the assessment. EI assessment challenges also include the lack of disaggregated data on pollutant emissions and the use of the EI data by decision-makers and HTA agencies. In the literature different methods and approaches have been proposed to incorporate EI in HTA; some rely on already establish assessment methods (“enriched” cost-utility analysis, adjusted willingness-to-pay, and multicriteria decision analysis (MCDA)) and other proposed more specific approaches as “information conduit”, “parallel evaluation”, “integrated evaluation”, and “environment-focused evaluation”.

CONCLUSIONS: HTA framework needs adjustments to incorporate environmental information, including environmental healthcare technology impact. Clear and robust methods on EI assessment and inclusion in HTA process should be provided by HTA agencies and international societies. Further, manufactures should improve the data generation on the EI of their products, with new studies able to generate individual-level data on environmental technology impact.