The Green Revolution in Health Technology Assessment: Environmental Value

Gavin Outteridge, Rachel Black, Catherine Chamoux

As the global focus on sustainability and environmental responsibility grows, it is only natural that healthcare systems and organizations are considering the environmental impact of healthcare products and technologies. The urgent need to address these concerns, from climate change to resource depletion, has prompted a closer look at the healthcare sector's contribution.?

Hospitals, pharmaceutical companies, and medical device manufacturers all play a role. Recognizing this, Health Technology Assessment (HTA) bodies, health systems, and pharmaceutical manufacturers globally are beginning to consider the environmental footprint of healthcare technologies. In this post, we'll explore the prominent players leading the charge, how stakeholders, including healthcare systems around the world, are responding, and the importance of generating and communicating evidence of environmental value.??

Where Environmental Value Assessment is coming to an HTA body near you?

HTA bodies in Canada, the UK, and France are now considering expanding the scope of their assessments to include environmental impact of pharmaceutical products, alongside traditional clinical and economic value pillars, with England’s National Institute for Health and Care Excellence (NICE) is pioneering the integration of environmental considerations into HTA, with plans to develop an approach to consider environmental impact data in its assessments by 20261. The Canadian Agency for Drugs and Technologies in Health’s (CADTH) strategic plan identified the need to develop methodologies for assessing healthcare technologies' environmental footprint.2 The French National Authority for Health (the Haute Autorité de Santé; HAS) has recently amended their strategic plan to integrate environmental criteria into their assessments, citing packaging and waste disposal as potential elements to be considered alongside carbon emissions.3??

This shift reflects a broader awareness of the need for healthcare technologies to align with environmental responsibility and sustainability goals, ensuring a more comprehensive understanding of their broader value beyond clinical and economic outcomes.?

How Health Systems and industry are already acting?

Environmental considerations are also being discussed at the health system level. The National Health System in England has committed to cutting its carbon emissions to net zero by 2045.? In the US, over 40 US healthcare systems, including two of the five largest private hospital and health systems (Ascension and CommonSpirit Health), have committed to reduce greenhouse gas emissions by 50% by 2030 in response to the Biden administration’s Health Sector Climate Pledge.? Healthcare systems in France and Australia have also voiced interest in incorporating similar environmental considerations.??

The pharmaceutical industry is actively engaging in sustainability initiatives. Executives from many top pharma companies have collaborated with the World Health Organization and other leading organizations to establish the Sustainable Markets Initiative's Health Systems Task Force, which aims to develop emissions measurement standards for the industry.? This commitment goes beyond compliance and reflects a growing awareness of the importance of environmental responsibility.?

Simultaneously, academic institutions and other non-profit organizations are taking a proactive role and independently developing methodologies and estimates for evaluating the environmental impact of healthcare technologies. A live example being work ongoing at ISPOR to establish a Special Interest Group (SIG). This action empowers a broader range of stakeholders to participate in the assessment process and develop the standards for data sources and analytical methods, which will be much needed for transparency and level playing fields.?

Is there a risk of doing less healthcare?

In 2022, NICE commissioned public opinion on how the organization should account for environmental sustainability in its decision-making and guidance. Participants indicated that healthcare should be made more sustainable, but not at the expense of access to high quality, effective care.? Healthcare organizations should engage in environmentally sustainable solutions that simultaneously advance healthcare and maintain high quality clinical outcomes.

More recently, CADTH released its Horizon Scan on Reducing the Environmental Impact of Clinical Care, a report that identifies opportunities to reduce health care’s environmental impact by ensuring the appropriate use of health care, reducing unnecessary health care, and rethinking and researching what and how health care is provided.? Residents of Sweden indicated willingness to take into account environmental considerations for treatments for minor ailments, though this trend gradually disappeared for more serious diseases.?

In the NICE report on public opinion, it was suggested that in cases where multiple care options exist that are comparable in terms of clinical and cost effectiveness, to recommend the more environmentally sustainable option as the default for new patients.?

Intuitively, anyone currently involved in healthcare decision-making should recognize the common approach of using the best data available to balance benefit, risk and cost. Considerations of environmental impact should therefore be addressed in a similar vein, contributing to a fuller picture of benefits and harms, rather than weighing too heavily on the downside. Similarly, HTA bodies could stay close to their customary scope by focusing on the environmental implications around the medication administration event, such as the carbon emissions of getting the product to the patient or the patient to the product.? Accordingly, the direction of travel for HTA bodies and HEOR/HTA methods development seems to be trending towards the focused and pragmatic.

How soon is this coming?

Scientifically-sound methodologies can take time to develop, test and validate. HTA agencies similarly tend to update their policies and approaches in steps rather than continually. It might be a few years before we see environmental value in national HTA – but we will see it, for products now in industry pipelines. Nevertheless, a "fourth value pillar" is already emerging at more local levels of decision-making alongside clinical, economic, and humanistic value: environmental sustainability.

As health systems and hospitals are increasingly required to measure and improve their sustainability performance, pharmaceutical manufacturers can leverage their environmental value proposition to differentiate their products. An AESARA Value & Access project team recently spoke with the Chief Pharmacist at a major UK teaching hospital, who indicated that if a product is clinically noninferior, he would be interested in seeing evidence of environmental value, such as lower carbon emissions or reduced materials waste at point of administration, for differentiation as a reason to switch from the standard of care.

In this way generating and communicating evidence of environmental value, with data and modelling on e.g. reduced materials waste or lower carbon emissions, can already provide a competitive edge in the market through creating an environmental element to a product’s overall value proposition.

Conclusion

A more holistic evaluation of healthcare technologies, that includes assessment of environmental impact represents a significant step forward in the quest for more sustainable healthcare. Organizations like NICE, CADTH, and HAS are pioneering this approach, inspiring healthcare organizations worldwide to follow suit. In the long term, sustainability will become an integral part of technology evaluation, shaping the future of healthcare innovation. In the mid-term, the pharmaceutical industry and academia are actively engaged in defining ways to measure environmental impact.

In the short term, by generating and communicating evidence of environmental value, companies can both gain a competitive advantage and highlight their real commitment to sustainability, in a way that supports delivery of healthcare systems' sustainability goals. This evolution aligns healthcare with global efforts to create a more sustainable future, where the health of both patients and the planet takes center stage.

Contact Gavin Outteridge, Rachel Black, or Catherine Chamoux to discuss how we can help you generate and communicate evidence of environmental value.

References

1.????? NICE. NICE strategy 2021 to 2026: Dynamic, Collaborative, Excellent. https://www.nice.org.uk/Media/Default/Get-involved/Meetings-In-Public/Public-board-meetings/Mar-24-pbm-NICE-strategy-2021-2026.pdf. Published April 2021. Accessed January 12, 2024.

2.????? CADTH. Ahead of the Curve: Shaping Future-Ready Health Systems 2022-2025 Strategic Plan. https://strategicplan.cadth.ca/wp-content/uploads/2022/03/cadth_2022_2025_strategic_plan.pdf. Published April 5th, 2022. Accessed January 12, 2024.

3.????? HAS. Roadmap Health Environment. https://www.has-sante.fr/jcms/p_3475965/fr/feuille-de-route-sante-environnement-de-la-has. Published November 23. 2023. Accessed January 12, 2024.

4.????? NHS England. Delivering a ‘Net Zero’ National Health Service. https://www.england.nhs.uk/greenernhs/publication/delivering-a-net-zero-national-health-service/. Published October 1st, 2020. Updated July 4th, 2022. Accessed January 12, 2024.

5.????? The White House. FACT SHEET:? Health Sector Leaders Join Biden Administration’s Pledge to Reduce Greenhouse Gas Emissions 50% by 2030. https://www.whitehouse.gov/briefing-room/statements-releases/2022/06/30/fact-sheet-health-sector-leaders-join-biden-administrations-pledge-to-reduce-greenhouse-gas-emissions-50-by-2030/. Published June 30th, 2022. Accessed January 12, 2024.

6.????? Sustainable Markets Initiative. GLOBAL HEALTHCARE LEADERS ADVANCE SECTOR DECARBONISATION AHEAD OF COP28. https://a.storyblok.com/f/109506/x/ea7b5e9da4/smi_health_systems_tf_release_24-11-2023_final.pdf. Published November 29th, 2023. Accessed January 12, 2024.

7.????? NICE. NICE Listens: Public dialogue on environmental sustainability. https://www.nice.org.uk/Media/Default/Get-involved/NICE-listens/Environmental%20sustainability%20final%20report.docx. Published February 2023. Accessed January 12, 2024.

8.????? CADTH. Reducing the Environmental Impact of Clinical Care. https://www.cadth.ca/reducing-environmental-impact-clinical-care. Published April, 2023. Accessed January 12, 2024.

9.????? H?konsen H, Dohle S, Rhedin H, Hedenrud T. Preferences for medicines with different environmental impact – A Swedish population-based study. Environmental Advances. 2023;12:100358.