Integrating environmental sustainability into health technology assessment: an international survey of HTA stakeholders

Health technologies play a relevant role in environmental sustainability (ES). However, limited evidence exists on approaches and methods to integrate ES into the Health Technology Assessment (HTA). The purpose of this study is: (i) to provide an overview of global HTA organizations’ progression toward the integration of ES into HTA; (ii) to investigate various paths for this integration, highlighting obstacles, priorities, potential approaches, and methods. Data were collected via questionnaires from organizations belonging to HTA networks, International Network of Agencies for Health Technology Assessment, and European Network for HTA. To complement the results of the survey, the authors carried out a desk analysis with strategic documents available on institutional websites. The survey included twenty-six respondents from twenty different countries (thirtythree percent response rate). Among the study’s participants, there is a notable acknowledgment of the importance of integrating ES into HTA. However, only nine organizations are actively engaged in these integration efforts, each employing unique methodologies and perspectives. There is a substantial consensus on the application of life cycle assessment, with a particular emphasis on the use of environmentally extended input–output analysis, and a stronger preference for cost-utility analysis. Nevertheless, evidence on integrating ES into HTA remains scarce. Major challenges identified include data collection difficulties and the necessity for interdisciplinary teams. Our study represents a preliminary effort to systematize initiatives aimed at integrating ES into HTA. Further research is required to customize methods and tools for appropriately evaluating the environmental impacts of technologies. The findings suggest that achieving ES-HTA integration demands a multi-tiered, interdisciplinary approach.