Sustainability and the way forward for HTAs

Written by Louisa Rutherford, Senior Systematic Evaluation Analyst

This weblog explores the intersection of local weather change and the well being expertise evaluation (HTA) course of. It examines how incorporating environmental affect information into the HTA course of may assist healthcare techniques obtain their sustainability targets. By integrating environmental concerns into the analysis of well being applied sciences, decision-makers can promote the adoption of extra sustainable practices and applied sciences, finally contributing to international local weather targets. To this finish, this weblog will talk about:

• An summary of the present state of local weather change and its implications for healthcare.
• The precise methods during which the HTA course of can evolve to incorporate environmental information.
• Benefits and challenges of this integration, and insights into how HTA businesses worldwide are starting to deal with these points.

Overview of the present state of local weather change and its implications for sustainability in healthcare

Local weather change is a world problem that impacts each sector, together with healthcare. The rising ranges of greenhouse gases (GHGs) are driving important modifications in our local weather, which pose critical dangers to public well being and the ecosystems we rely on (1).

All industries, together with healthcare, emit GHGs. In 2014, it was estimated that healthcare produced 4.4% of world web carbon dioxide (CO₂) emissions (2). In England, it’s estimated that NHS England contributes to 4% of the nation’s GHG emissions, with the estimated contribution of the prescribed drugs business being 20% (3, 4).

Methods to scale back and handle the dangers of local weather change have been agreed on throughout landmark conferences hosted by the United Nations Framework Conference on Local weather Change (UNFCC). Determine 1 reveals a timeline summarising the conferences and Intergovernmental Panel in Local weather Change (IPCC) studies inside the final three many years.

Determine 1: Timeline summarising landmark COPs and publications

COP, Convention of Events; IPCC, Intergovernmental Panel in Local weather Change; NHS, Nationwide Well being Service.

COP26 in Glasgow 2021 noticed 36 nations making commitments to develop low-carbon well being techniques with an additional 14 nations, together with the UK, setting a goal for a net-zero well being service by 2050 (5). If these targets are to be met, healthcare decision-makers might want to contemplate and perceive the environmental affect of services and products utilized by their well being companies. In England, this contains the environmental affect from procured well being applied sciences permitted by way of the HTA course of.

With the data that well being applied sciences permitted by the HTA course of develop into built-in into on a regular basis scientific follow, if applied sciences with low environmental affect are taken ahead, this can assist the well being sector obtain its web zero targets with optimistic knock-on results at a neighborhood and, finally, a world stage.

How the HTA course of may evolve to deal with sustainability in healthcare

Lately printed literature discussing well being expertise evaluation (HTA) methodology has included dialogue on how environmental information could possibly be included within the HTA decision-making course of and which HTA organisations are making progress on this space (6-10). Steered approaches to include environmental information embody:

• Publishing environmental affect information that’s already publicly accessible with out additional evaluation, so it sits alongside an present cost-effectiveness evaluation.
• Finishing up additional analyses of environmental affect information that’s offered alongside scientific and value outcomes, however it’s not integrated into the cost-effectiveness mannequin.
• Creating or figuring out new fashions that permit scientific, value, and environmental information to be assessed in a single quantitative evaluation.

An instance of the place an environmental centered analysis has been carried out on a expertise is with inhalers for managing bronchial asthma. Metered dose inhalers and breath-actuated inhalers include a propellant fuel that contributes to local weather change. Every puff of some inhalers can produce as a lot carbon dioxide equal (CO₂e) in kilograms, as a 115-‍mile petrol automobile journey (35 kg CO₂e). In distinction, dry powder inhalers or mushy mist inhalers produce lower than 1kg CO₂e per dose. Carbon dioxide equal is the unit of measurement for the warming impact of GHGs. In essence it’s the trade fee of different GHGs to carbon and permits comparability of the impact between completely different GHGs. NICE has produced a choice help in order that sufferers can now make a alternative about which sort of inhaler to make use of (11).

Benefits and challenges of this integration and insights into how HTA businesses worldwide are starting to deal with these points

There are particular professionals and cons related to every of the person approaches described above. Nonetheless, there are maybe benefits and challenges frequent to all strategies and these are described in Desk 1.

Desk 1: Benefits and challenges of integrating environmental affect information into the HTA course of

Analysis means that HTA businesses have began to gather and use environmental affect information; nevertheless, it’s not taking place routinely. In a single publication, the authors report that out of 14 HTAs from six nations – Pharmaceutical Advantages Advisory Committee (PBAC) in Australia, Canada’s Drug Company (CDA), Haute Autorité de Santé (HAS) in France, Sistema Sanitario Regione Liguria (ALISA) and Programma Regionale HA Dispositivi Medici (PHRDM) in Italy, Institute for Medical and Financial Evaluation (ICER) within the US, and Nationwide Institute for Well being and Care Excellence (NICE) within the UK – environmental components appeared to have an effect on the ultimate resolution in six HTAs however was not the primary resolution driver in any. Notably, seven HTA businesses in Canada, France, UK, USA, Netherlands, Sweden, Spain have produced insurance policies or methodology tips that embody environmental concerns (9).

 Key takeaways

There are a number of key takeaways to notice:

• If healthcare is to play its half in reaching the web zero targets set by governments, change in thought and methodology on procurement of well being applied sciences is required.
• Single organisations won’t be able to beat the challenges alone and it’ll take a collaborative effort between pharmaceutical corporations, healthcare suppliers, governments, regulatory authorities, and sufferers.
• Whereas there are challenges related to any change in course of, the best way the present HTA course of has advanced extra time means that it’s doable to combine environmental information.
• It’s encouraging to see that a number of HTA businesses have began exploring how this integration may happen.

If you need to be taught extra about HTA submissions (together with systematic critiques, well being financial modelling, and medical writing), please contact us at Supply Well being Economics, a HEOR consultancy specialising in proof era, well being economics, and communication.

References

1. IPCC. Accessible at: https://www.ipcc.ch/assessment-report/ar5/ (final accessed 23^rd October 2024). 2014
2. Pichler P-P. Environ. Res. Lett. 2019;14(6)
3. NHS England. Accessible at: https://www.england.nhs.uk/greenernhs/ (final accessed 23^rd October 2024).
4. NHS England Carbon Emissions Carbon Footprinting Report. September 2008 (up to date August 2009)
5. UNFCC. Accessible at: https://unfccc.int/ (final accessed 23^rd October 2024)
6. Greenwood Dufour B. Int. J. Environ. Res. Public Well being 2022, 19, 12017.
7. Toolan M. Worldwide Journal of Expertise Evaluation in Well being Care, 39(1), e13, 1–4
8. McAlister S. Lancet Planet Well being 2022; 6: e993-99
9. Szawara P. Poster by IQVIA offered at ISPOR Europe 2023
10. Thomson D. Cochrane Database of Systematic Evaluations 2022, Problem 3. Artwork. No.: ED000156
11. NICE steering on Bronchial asthma inhalers and local weather change. https://www.good.org.uk/steering/ng80/sources/inhalers-for-asthma-patient-decision-aid-pdf-6727144573 (final accessed on twenty third October 2024)