title: Expanding Health Technology Assessments to Include Effects on the Environment.
abstract: There is growing awareness of the impact of human activity on the climate and the need to stem this impact. Public health care decision makers from Sweden and the United Kingdom have started examining environmental impacts when assessing new technologies. This article considers the case for incorporating environmental impacts into the health technology assessment (HTA) process and discusses the associated challenges. Two arguments favor incorporating environmental impacts into HTA: 1) environmental changes could directly affect people's health and 2) policy decision makers have broad mandates and objectives extending beyond health care. Two types of challenges hinder this process. First, the nascent evidence base is insufficient to support the accurate comparison of technologies' environmental impacts. Second, cost-utility analysis, which is favored by many HTA agencies, could capture some of the value of environmental impacts, especially those generating health impacts, but might not be suitable for addressing broader concerns. Both cost-benefit and multicriteria decision analyses are potential methods for evaluating health and environmental outcomes, but are less familiar to health care decision makers. Health care is an important and sizable sector of the economy that could warrant closer policy attention to its impact on the environment. Considerable work is needed to track decision makers' demands, augment the environmental evidence base, and develop robust methods for capturing and incorporating environmental data as part of HTA.
authors.affiliation: Evidera Inc., London, UK. Electronic address: kevin.marsh@evidera.com.
authors.forename: Kevin
authors.initials: K
authors.lastname: Marsh
authors.affiliation: Evidera Inc., Lexington, MA, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Ganz
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Hsu
authors.affiliation: Centre for Health Economics and Policy, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Strandberg-Larsen
authors.affiliation: Independent Researcher, Kampala, Uganda.
authors.forename: Raquel Palomino
authors.initials: RP
authors.lastname: Gonzalez
authors.affiliation: Novo Nordisk A/S, Bagsværd, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Lund
mesh_terms: D057231:Climate Change; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004777:Environment; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D018803:Models, Economic; D011050:Policy Making; D011634:Public Health / Q000191:economics / Q000331:legislation & jurisprudence; D018570:Risk Assessment; D012946:Social Welfare; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods*
keywords: economic evaluation; environmental impacts; health technology assessment