Integrating Environmental Impact in Health Technology Assessment: An Exploratory Study

Area of Science:

• Environmental Health Sciences
• Health Economics
• Public Health Policy

Background:

• The environmental impact of healthcare pollution on future health remains an under-evaluated aspect of care pathway assessment.
• Existing health technology assessment (HTA) metrics may not fully capture the long-term health detriments caused by pollutants.

Purpose of the Study:

• To develop a methodological framework for integrating pollutant-induced future health damages into HTA metrics.
• To evaluate the cost-effectiveness of care pathways by considering both patient benefits and environmental costs.

Main Methods:

• Utilized the ReCiPe model to quantify future health impacts (DALYs) from US healthcare system pollutants, identifying GHG emissions as the primary concern.
• Adapted the ReCiPe model to convert GHG emissions into future health damages (DALY_GHG, QALY_GHG, LY_GHG) with confidence intervals.
• Compared future health damages with patient benefits (e.g., QALY_GHG/QALY_patient) and integrated damages into incremental cost-effectiveness ratios (ICER_GHG).

Main Results:

• Pollutants from the US healthcare system cause an estimated 7,363,000 DALYs annually, with GHG emissions accounting for over 90% of future damages.
• Estimates for converting GHG emissions into future health damages across different time horizons and discount rates are provided.
• Integrating GHG emissions into ICERs significantly impacts the cost-effectiveness of care pathways, potentially favoring greener alternatives and highlighting limitations of chronic treatments in low-risk populations.

Conclusions:

• HTA must incorporate the impact of care pathways on future health for comprehensive assessment of health technologies.
• Accounting for GHG emissions under an egalitarian perspective (0% discount rate) is recommended for intergenerational equity.
• The integration of GHG accounting can incentivize the development of environmentally sustainable care pathways by healthcare providers and pharmaceutical companies.