It’s a busy time for sustainability in healthcare:
- 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 critical topic is gaining traction in health policy, the MedTech industry, hospitals, and Health Technology Assessment (HTA) circles. Many of us, including myself, are exploring how to thoughtfully integrate the planet’s sustainability needs into our work.
We all want to contribute to a healthier planet.
(Well, most of us do – though a few anaesthetists still using desflurane, a greenhouse gas more harmful than other anaesthetic agents, might need a nudge!)
The challenge lies in how the MedTech industry can practically and affordably incorporate sustainability assessments into healthcare interventions.
My team and I attended the ISPOR Australia Chapter Incorporating Sustainability in HTA conference to explore how sustainability could fit into the HTA process.
I’m all for brainstorming ways to ensure the planet thrives for centuries, but I was intrigued by suggestions from academic researchers that we could relatively easily incorporate an intervention’s carbon footprint into the HTA process alongside clinical and cost-effectiveness assessments. They presented a decision criteria matrix to weigh environmental impact with traditional cost-effectiveness in HTA (image below). The proposal was for sponsors to calculate and include a sustainability factor (or carbon emissions rating) in their PBAC/MSAC submissions, which decision-makers could use to inform listing recommendations.
How would this work in practice?
If a sponsor proposes a non-inferior clinical claim but with a less favourable sustainability profile, PBAC/MSAC might consider this in their decision-making.
Alternatively, a sponsor could claim a superior sustainability rating compared to the comparator, but this would need robust scientific justification. Where would reliable comparator data come from?
Decision-makers can’t simply compare a single carbon emission score of a proposed intervention against its comparator. A comprehensive sustainability model, aligned with the health states in the economic model, would be needed to calculate an incremental sustainability-effectiveness ratio (ISER). This could involve assessing emissions from hospital treatment, recovery, specialist visits, home care, virtual care, concomitant therapies, single-use devices/plastics, waste management, transport, carer activities, and even emissions from Phase I, II, and III clinical trials.
How practical is this?
Key questions remain:
- Where will patient, carer, and healthcare system sustainability data be sourced?
- How feasible is it to collect and analyse these data comprehensively?
If the government mandates sustainability data in HTA submissions, the MedTech industry will face significant challenges.
Developing a sustainability framework to guide the measuremen of resource use, energy consumption, waste generation, and emissions would require substantial investment.
What’s the impact?
Adding sustainability assessments would:
- Inform and shape PBAC/MSAC decisions on the availability of vital subsidised therapies by factoring in environmental impact.
- Encourage innovation in developing greener healthcare interventions as part of complex biomedical R&D pipelines.
- Increase costs for companies, which could affect pricing.
- Require regular updates to sustainability data, given the rapid pace of healthcare innovation.
Moving forward
Integrating environmental sustainability into HTA is a complex but potentially worthwhile goal. For now, we need to carefully consider how to balance these assessments with practicality, innovation, and without harming patient access to important preventive and therapeutic interventions.
