Prioritising environmental determinants in health technology assessment: a framework for integrating environmental...

Environmental determinants, such as air pollution, climate change, water quality, and waste, substantially influence population health, yet health technology assessment (HTA) rarely considers how health-care technologies affect these determinants and their downstream health consequences. In this Personal View, we propose a four-step prioritisation framework to identify the environmental determinants that should be prioritised for consideration in HTA. The framework maps causal pathways linking health-care technologies to environmental determinants across the lifecycle; assesses potential population health impacts; evaluates feasibility across five domains-strength of evidence, data availability, measurement standardisation, continuity of data collection, and alignment with existing HTA processes; and positions determinants within an impact-feasibility matrix to inform prioritisation. We demonstrate application of our framework using fine particulate matter (PM_2·5) associated with vaccine packaging as an illustrative worked example. By considering potential population health impact alongside feasibility for HTA, the framework can help identify the environmental determinants that warrant detailed assessment and those for which current evidence or data are insufficient to support assessment within HTA.