Two environmental sustainability in healthcare conferences/webinars in one week? You must be joking.
But no, it’s no joke.
ISPOR Australia Chapter: Incorporating Sustainability in HTA conference (23 July 2024)
Australian Healthcare and Hospitals Association: Sustainability Accelerator Tool (SAT) webinar (25 July 2024)
This crucial topic is gaining momentum within health policy, the MedTech industry, hospitals and in Health Technology Assessment (HTA) circles. Many of us, including myself, are grappling with how to incorporate the earth’s sustainability needs into our everyday work.
Of course, we all want to help the planet…
Well, most of us do anyway (unsure about the few anaesthetists continuing to use desflurane – a harmful greenhouse gas than other commonly used anaesthetic agents)!
The issue is that it’s not clear how the MedTech industry is going to navigate and fund sustainability assessment for their healthcare interventions.
My team and I attended the ‘ISPOR Australia Chapter Incorporating Sustainability in HTA’ conference last week to discuss how we can integrate sustainability into the HTA process.
Now, I’m all for brainstorming ideas to improve the planet’s likelihood of surviving for centuries to come, but I was perplexed when some academic researchers suggested we could EASILY incorporate an assessment of an intervention’s carbon footprint following the clinical and cost-effectiveness assessment. The researchers presented a decision criteria matrix to incorporate environmental impact alongside traditional cost-effectiveness in HTA (image below). The researchers proposed that sponsors calculate and present a sustainability factor (or carbon emissions rating) for their interventions within their PBAC/MSAC submissions. These data could then be used by decision-makers to inform recommendations on new listings.
How would this look in practice?
If a sponsor proposes a non-inferior clinical claim with poorer sustainability, PBAC/MSAC could reject it.
Alternatively, a sponsor may propose a superior sustainability rating for their intervention versus the comparator. This claim would need to be scientifically justified and where would the comparator data be sourced from?
The decision makers cannot reliably compare a single carbon emission score of a proposed intervention to that of its comparator to make their decision. The carbon emissions of each patient health state would need to be included in a sustainability model (with the same health states presented in the economic model) to calculate an incremental sustainability-effectiveness ratio (ISER). A full assessment of sustainability could include the patient’s hospital treatment/recovery, specialist visits, home care, virtual care, concomitant therapy, single-use devices/plastics, waste management, transport emissions, carer emissions etc. What about the carbon emissions emitted during the Phase I, II and III clinical trials?
How practical is it to collect and analyse these data?
Where will the patient/carer/healthcare system sustainability data be sourced from?
If the government requires MedTech companies to present sustainability data in HTA submissions, then the healthcare industry is in for a shock.
What will be the cost for companies to develop the sustainability framework and calculate the resource use, energy consumption, waste generation, and emissions for an intervention?
Surely millions.
And to what end?
A sustainability factor to support a PBAC/MSAC decision to reject reimbursement of a novel healthcare intervention.
Plus:
Increased prices.
Stifled innovation.
Fewer treatment options for patients.
Furthermore, the rapid pace of healthcare innovation means any estimated sustainability factor will be outdated within a few years.
It’s a lot to consider.
For the time being however, let’s keep environmental sustainability assessments out of HTA.
