OBJECTIVES: Nowadays, the carbon footprint of a healthcare product is not included in the health technology assessment process in France. Environmental factors will become increasingly important in the decisions taken by health authorities, as the recently published institutional roadmaps suggest.

METHODS: The various methods of integrating carbon impact into the results of a medico-economic study were analysed through a literature review, which also facilitated the structural choices for the modelling and enabled the research for emission factor data. An economic model combining costs and carbon emissions was developed to compare various healthcare pathways associated with different treatment options in chronic lymphocytic leukaemia (CLL).

RESULTS: The incremental cost-carbon ratio, expressed as a cost per unit of CO₂ equivalent (CO₂e) avoided, can therefore be calculated, making it possible to rank the various treatments proposed in the first line of CLL according to their environmental impact, in relation to their costs. The availability of French data on the emission factors associated with the different steps of the treatment pathway is currently an obstacle to the development of these models and is associated with a high degree of uncertainty. In addition, the lack of data on the life cycle analysis of treatment limits the robustness of the results at this stage.

CONCLUSIONS: The publication of guidelines on integrating the carbon criterion into health technology assessments and the availability of more comprehensive emission factor data should enable decision-makers to use these models more widely. To date, the development of this type of model can inform the various stakeholders and raise their awareness of the environmental challenges facing healthcare.