OBJECTIVES: Broadening the dimensions of value in healthcare by incorporating further value elements in established cost-effectiveness analysis (CEA) is a topic of discussion. An important factor to consider are environmental costs, namely the impacts on the environment resulting from a health products’ development, production, distribution, use, and disposal. However, including this dimension in CEAs would have equity implications and distributional consequences. The objective of this work is to explore the perception of multiple stakeholders on this issue.

METHODS: As part of the Horizon Europe project HI-PRIX (Grant Agreement: 101095593), semi-structured interviews were conducted. An interview template was developed, pilot tested, and ethically approved. The interviewees were purposely selected to represent different geographies and perspectives. The interviews were conducted online and lasted 45 minutes. All the interviews were recorded and transcribed.

RESULTS: Overall, 17 stakeholders were contacted, and 13 agreed to be interviewed. The interviewees represented seven countries (Belgium, France, Ireland, Netherlands, Portugal, Spain, United Kingdom) and various roles in stakeholder organizations, divided into payers (national HTA and/or regulatory bodies, hospital-based HTA), academics, and industry. In general, interviews showed uncertainty whether CEAs are the right place to start incorporating environmental impact due, e.g., to unresolved methodological challenges and incomplete data. This would require a shift from a health system to a societal perspective for most HTA agencies. Furthermore, correct attribution of environmental costs is a primary concern to industry.

CONCLUSIONS: In principle, the environmental impact of health technologies can be used to widen the evidence base for pricing and reimbursement decisions. However, while “environment” has become a mantra of the modern era, with a variety of stakeholders demanding concrete actions to protect the environment, for the time being, procurement (using rewards and/or penalties) may be a more direct route to encouraging more ecologically responsible decisions on what to allow or finance.