Introduction
Sustainability has emerged as one of the most critical global challenges, driving efforts to curb climate change and limit the rise in global temperatures. While industries across the board are under scrutiny for their carbon footprints, the healthcare sector—one of the significant contributors to global emissions—has largely escaped such attention. This article examines how Health Technology Assessments (HTAs) are evolving to integrate sustainability considerations into healthcare decision-making processes.
What is a Health Technology Assessment (HTA)?
Health Technology Assessments (HTAs) are systematic evaluations that assess the value of health technologies, aiming to promote equitable, efficient, and high-quality healthcare systems. Traditionally, HTAs have focused on clinical effectiveness and cost-effectiveness, but the tide is shifting. Increasingly, HTA agencies are beginning to factor in the environmental impact of healthcare technologies alongside traditional metrics.
Integrating sustainability into HTAs
Sustainability, defined as meeting current needs without compromising the ability of future generations to meet theirs, is increasingly being recognised as a crucial consideration in healthcare1. Despite growing commitments from pharmaceutical companies, the healthcare sector’s global CO2 emissions are comparable to those of the fifth-largest emitting country. As such, balancing environmental impact with product quality and effectiveness has never been more important.
HTA sustainability assessments examine a technology’s environmental impact throughout its lifecycle, from production to disposal. For example, robot-assisted surgery, which generates higher emissions and waste compared to traditional laparoscopy, has been approved through HTAs despite offering minimal or unproven patient benefits.2
The growing trend of sustainability in HTA
Awareness of healthcare’s environmental impact is leading more HTA bodies to incorporate sustainability into their evaluations. Notable examples include:
- Canadian Drug and Health Technology Agency (CADTH): CADTH has produced a report on environmental sustainability and climate change in healthcare, providing insights into how clinical care can be made more sustainable3
- Irish Health Information and Quality Authority (HIQA): HIQA has begun discussing environmental consequences in HTA reports, such as considering the environmental impact of air travel in paediatric haematopoietic stem cell transplants4
- National Institute for Health and Care Excellence (NICE), UK:
- Published a decision aid to help asthma patients choose inhalers with a lower carbon footprint5
- Released an evidence summary on desflurane, a general anaesthetic agent with high global warming potential, to support the NHS’s policy to phase out its routine use by early 2024, in line with an EU directive6
- Conducted an options appraisal on requesting and using product-level environmental data in HTAs7
- Ministry of Health, Spain: The Ministry has announced plans to incorporate environmental impact into the assessment and funding of medicines, with a focus on products like inhalers. Additionally, Spain’s healthcare system aims to achieve carbon neutrality by 20508
Sustainability in other healthcare assessments
A few Integrated Care Systems in the UK have begun considering sustainability in their formulary submissions, which determine the drugs covered. They are asking questions such as:
- What is the carbon footprint of the medication?
- What is the environmental toxicology of the medication?
- Is any part of the medication reusable?
- Can details be provided on the medication’s environmental impacts?
- Does the medication support or promote environmental sustainability?
However, it remains unclear how much these sustainability questions currently influence decision-making processes.
Conclusion
The debate on how best to assess the environmental impact of healthcare products is ongoing. Potential approaches include life cycle assessments and cost-effectiveness analyses that incorporate environmental factors. Although the integration of sustainability into HTA decision-making is still in its early stages, the momentum is growing. Manufacturers will increasingly need to address the environmental impact of their products. In the future, considerations may include rewarding environmentally friendly products or even excluding those with high environmental impacts and minimal clinical benefits. However, fully embedding sustainability into healthcare decision-making processes may still take time.
As a leading market access consultancy, we understand the evolving landscape of Health Technology Assessments (HTAs) and the increasing importance of sustainability in healthcare decision-making. With the upcoming EU HTA regulations for Oncology and Advanced Therapy Medicinal Products (ATMPs) set to take effect in January 2025, now is the time to ensure your products are not only clinically effective and cost-efficient but also environmentally sustainable.
Don’t navigate these changes alone. Our expert team is here to support you in navigating the complexities of HTAs, helping you align with new regulatory requirements and ultimately improving patient access to your innovative therapies.
Contact us today to learn how we can partner with you to ensure your products are ready for the future of sustainable healthcare.