Background 

Healthcare agencies around the world are increasingly interested in integrating environmental sustainability into decision making, factoring this into strategic plans, pilot projects and proposed assessment considerations. 

Several questions remain, however. Many of these were brought up at the recent ISPOR Europe 2025 conference:  

• What should be included within the scope of environmental impact? For example, should the evaluation address just the technology itself, or its implementation in a healthcare system? 
• How should a technology’s environmental impact be measured? 
• When and how should this be weighted and incorporated into decision-making? 

Anticipating Technologies Subject to Environmental Considerations in Future HTA 

Recognizing both this uncertainty and the need for a pragmatic focus from the perspective of technology developers, Avalere Health presented research at ISPOR EU on which technologies this will be most relevant at HTA.  

A broad definition of environmental considerations is within current HTA agencies’ scope. While quantification methodologies frequently focus on greenhouse gas (GHG) emissions, HTAs recognize that the environmental impact of healthcare also encompasses pollution, resource depletion, and waste.  

The current literature highlights GHGs in inhalers and anaesthetics, as well as resource use and waste associated with single-use medical devices. However, published carbon footprint or lifecycle analyses cover disparate interventions and indications and no selection criteria for evaluations, such as magnitude of environmental impact, were identified. Literature highlighted the potentially broad definition of environmental impact – including eco-toxicity of pharmaceutical waste and biodiversity loss from sourcing of raw materials. 

Given the current landscape, manufacturer should not limit consideration of environmental impact to particular technologies — although high impact of some technologies should be noted. However routine inclusion of all environmental factors in HTA may be unlikely: priority may be given to the most impactful or most feasible assessments, although how this will be implemented is unclear. 

Extending beyond HTA, it is important to highlight the more mature role of environmental considerations in tendering and procurement. Implementation examples include evaluations of waste eco-toxicity of common pharmaceuticals in Norway and Sweden, a requirement for the carbon foot-printing of individual products supplied to the UK NHS, and potential inclusion of environmental conduct criteria in European-level procurement. Although decisionmakers’ approaches differ—especially from HTA for innovative, patented products—how environmental impact is considered in tendering may be important to understand the shape of future application in HTA.  

Conclusion 

We continue to monitor the emergence of environmental considerations across HTA and instances in which it is criteria for tendering. Avalere Health’s experts in global market access would be pleased to explore this topic further and understand how we could support you across key markets. To learn more, connect with us. 

Read our ISPOR Europe poster, “Navigating uncharted waters: challenge of anticipating technologies subject to environmental considerations in future health technology assessment.”