Environmental Assessment in HEOR

1. Foster Membership Community and Education: Bring Together & Educate the Membership: Foster a collaborative, multi-stakeholder dialogue with leading experts ranging from HEOR professionals, environmental economists, clinicians, patients, the public and other decision-makers to expand awareness, education, and community engagement on issues emerging from this intersection of HEOR / whole health and climate resilience / environmental sustainability
2. Current Situation Assessment: Determine SIG priorities based on holistic scoping of existing landscape, potentially including literature reviews and qualitative research to:
   • Understand current level and methods of HEOR use in supporting achievement of environmental sustainability goals (e.g., net zero commitments)
   • Identify potential benefits and limitations of existing LCA, patient pathways, “green HTA”, and other nascent methods
3. Frameworks & Data Generation: Promote the development and use of standardized environmental assessment frameworks and encourage/facilitate the data generation and dissemination needed to inform them
   • Encourage and enable research to identify quantifiable environmental metrics (e.g., carbon footprint) and broader holistic impact considerations (e.g., waste, water use, fine particulate matter, environmental degradation, etc.) to be recommended for inclusion in value assessment
   • Catalogue publicly available data sources, evaluating their quality, and recommending whether or not to include them in environmental impact assessments; encourage industry and other stakeholders to collect and publish environmental impact data
4. Incorporation of Environment into “Whole Health”: Ultimately, create an avenue for environmental and ‘whole health’ to be incorporated into decision making by creating frameworks where climate resilience and environmental sustainability metrics are fully considered health economics research
   • Broaden the discussion of environmental sustainability in healthcare beyond evidence generation and evaluation of new technologies, to raise awareness of the need to identify trade-offs that may be developed by regulators and required of the life sciences sector

The life sciences industry is a significant contributor to greenhouse gas emissions; this presents a paradox of sorts: health technology aims to improve human health, but its negative environmental impacts can do the opposite¹. This paradox is pertinent to ISPOR’s exploration of “whole health”, which encompasses not only patient care but also the “physical, behavioral, spiritual, and socioeconomic well-being as defined by individuals, families, and communities”, and which is commonly extended to include environmental impacts on human health². Because of this, quantifying the environmental impact of health technology is a “critical emerging school of thought”, with increasing interest from industry, academia, and the public. This is evident in that many leading healthcare companies and wider healthcare delivery systems/organizations are targeting “net zero emissions” and other environmental goals^3,4

While there is demonstrated interest in quantifying environmental impacts of health technology and incorporating these metrics into decision-making, there are not standardized methods, nor is there existing academic / professional society leadership on how to go about it⁵. Approaches on how to incorporate environmental considerations into HTA and HEOR exist; however, these are disjointed, based on insufficient data, and are limited in their scope; other paths to next zero are also being explored (e.g., care pathway redesign, health systems updates), but methods for weighing risks, investment and return are inconsistent. NICE is leading the way, but lack of standardization and data availability remain serious challenges⁶. The Sustainable Healthcare Coalition has also published select guidance and resources on LCA and other tools but is limited by the data they can access³. These factors result in a risk of underrepresenting or improperly quantifying evidence utilized in HTA / value assessments to date and inhibiting growth and utilization of the tools in this context. As environmental damage disproportionately impacts those with lower means, this is also an emerging equity issue⁷.

Because of this, there is demand from a wide variety of stakeholders, including physicians, payers, buyers, patients, and regulators to improve the ability to quantify and make decisions around these impacts, to augment the availability of data upon which this measurement relies. HEOR as a field of science can provide the methods tools to enable healthcare decision makers to achieve across these areas, by elucidating effective incentives and enabling the efficient allocation of healthcare and planetary resources. A small number of papers on this topic are emerging, but researchers and ideas are scattered, lacking the centralized, international and credible structure. This group will generate a robust and ongoing dialogue on the intersection of health, environmental, and economic policy and how to enable more sustainable healthcare systems.

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