OBJECTIVES: Previous discussions at ISPOR focused on the theoretical aspects of incorporating environmental impacts into HTA. However, there was a lack of practical consideration on how this incorporation could be implemented. The challenges related to assessing greenhouse gas (GHG) emissions are not unique to the field of HEOR. Other sectors, such as clinical trial conduct, have also faced methodological and data availability challenges when assessing GHG emissions; learning from initiatives in other industries can provide valuable insights. The objective is to go beyond theoretical considerations by testing the feasibility of accounting for carbon emissions in HTA.

METHODS: We provide a practical example of methods for incorporation of carbon footprint assessment into HTA inspired by methods used in clinical trial conduct. We assess the carbon footprint of alternative treatments – pomalidomide, carfilzomib, and subcutaneous daratumumab – for patients with heavily pre-treated relapsed–refractory multiple myeloma via a partial life-cycle analysis. We calculate direct and indirect impact of treatments on carbon emission. Building on prior published cost-effectiveness results we propose potential ways of presenting carbon footprint alongside traditional cost, QALY, and cost-effectiveness results to demonstrate the concept of a “parallel environmental evaluation”. We showcase an approach for an “evaluation integrated into HTA” by converting GHG emissions into monetary values using alternative concepts. We demonstrate an exploratory method for calculating carbon emission adjusted economically justifiable price.

RESULTS: We present the reduced carbon emissions associated with subcutaneous injection compared with IV treatments.

CONCLUSIONS: We describe synergies between data generation for carbon emission assessment in trials and for HTAs, alongside challenges encountered and solutions implemented related to methodology and data availability.