Incorporating environmental and sustainability considerations into health technology assessment and clinical and public health guidelines: a scoping review

Abstract

Healthcare systems account for a substantial proportion of global carbon emissions and contribute to wider environmental degradation. This scoping review aimed to summarize the evidence currently available on incorporation of environmental and sustainability considerations into health technology assessments (HTAs) and guidelines to support the National In stitute for Health and Care Excellence and analogous bodies in other jurisdictions developing theirown methods and processes. Overall, 7,653 articles were identified, of which 24 were included in this review and split into three key areas – HTA (10 studies), healthcare guidelines (4 studies), and food and dietary guidelines (10 studies). Methodological reviews discussed the pros and cons of different approaches to integrate environmental considerations into HTAs, including adjustments to conventional cost-utility analysis (CUA), cost–benefit analysis, and multicriteria decision analysis. The case studies illustrated the challenges of putting this into practice, such as lack of disaggregated data to evaluate the impact of single technologies and difficulty in conducting thorough life cycle assessments that consider the full environmental effects. Evidence was scant on the incorporation of environmental impacts in clinical practice and public health guidelines. Food and dietary guidelines used adapted CUA based on life cycle assessments, simulation modeling, and qualitative judgments made by expert panels. There is uncertainty on how HTA and guideline committees will handle trade-offs between health and environment, especially when balancing environmental harms that fall largely on society with health benefits for individuals. Further research is warranted to enable integration of environmental considerations into HTA and clinical and public health guidelines.

Main Challenges of Incorporating Environmental Impacts in the Economic Evaluation of Health Technology Assessment: A Scoping Review

“…Similar to Polisena et al [ 20 ], we did not evaluate the methodological quality of the selected studies given the aim of the scoping review to identify cases and challenges. Finally, during the review process of this article, two relevant articles on the topic published after our search alert deadline were identified: Mc Alister et al (2022) [ 54 ] and Pinho-Gomes et al (2022) [ 55 ]. On the one hand, Mc Alister et al (2022) [ 54 ] conducted a narrative review to investigate how to integrate carbon emissions calculated by LCA into HTA.…”

“…The authors considered carbon emissions over other environmental impacts since the former should be the main immediate concern to limit global warming. On the other hand, Pinho-Gomes et al (2022) [ 55 ] carried out a scoping review to update the evidence available on the incorporation of environmental and sustainability considerations into HTAs and guidelines. The authors purpose were providing support to the National Institute for Health and Care Excellence (NICE) in the development of their own methods and processes.…”

Pharmacological and Benefit-Risk Profile of Once-Weekly Basal Insulin Administration (Icodec): Addressing Patients’ Unmet Needs and Exploring Future Applications

“…The environmental impact related to drugs manufacturing represents a critical issue for the entire society. Regulators are seriously taking into account this aspect by implementing the environmental impact in the Health Technology Assessment (HTA) evaluation of new drugs [76,77].…”

Health technology assessment and healthcare environmental sustainability: Prioritizing effort and maximizing impact

“…While much of the focus on "sustainability" has understandably been driven by recognition of the increasingly urgent need for action on decarbonization and climate change, most strategies clearly recognize the importance of other aspects of environmental sustainability beyond climate change (3) and the broad-spectrum ecological crisis that now sees human impacts pushing outside the safe operating spaces for six out of nine "planetary boundaries" (4). Unsurprisingly, health technology assessment (HTA) agencies, researchers, and industry have also become increasingly interested in these sustainability challenges and in whether and how best to incorporate them within HTA processes (5)(6)(7)(8). Yet much of the discussion of how to include environmental impacts within HTA evaluation has tended to move very quickly to methodological issues (e.g.…”