Beyond carbon footprints: Four methodological extensions for environmental sustainability assessment in health technology assessment
When environmental outcomes are included in health economic analyses, many studies tend to focus only on the direct carbon footprint of the technologies being assessed. However, this narrow approach ignores several highly important factors. This article is intended to be an opening proposition rather than claiming to have fully formed answers. It proposes four additions to the environmental evaluation of healthcare interventions. The first is to include all downstream impacts. The second is to account for the environmental impact of displaced healthcare funding. The third is to account for the environmental impact of changes in life expectancy. Finally, the fourth recommendation is to use a decision rule to compare trade-offs between health gains (or losses) and environmental harm (or benefit). A hypothetical case study is used to illustrate how each of these recommendations can change the results of an evaluation. It is demonstrated that, whilst the narrow approach implied that a new technology might reduce environmental harm (a 5 kg reduction in CO2 equivalent emissions), the wider considerations demonstrate that the impact may be far larger (an increase of 19,119 kg CO2 equivalent emissions). Although the case study is hypothetical, the principles demonstrate that ignoring the wider impacts of health policies may miss important consequences.
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