Following on from similar discussions at ISPOR Europe 2024, incorporating environmental sustainability into value and access discussions was a hot topic at ISPOR Europe 2025.1–4
Incorporating environmental sustainability was often discussed in the context of ISPOR’s strategic focus on Whole Health in their 2030 Strategic Plan, which calls for a holistic approach to healthcare to incorporate physical, mental, social, environmental, and spiritual dimensions of wellbeing, moving beyond clinical efficacy and cost, to include wider determinants of health.5
While there have been some significant developments since ISPOR Europe 2024, including the launch of the ISPOR special interest group (SIG) for Environmental Assessment in Health Economics and Outcomes Research (HEOR), not much seems to have changed in terms of clarity on which decisions environmental sustainability should inform and how best to capture the environmental impact of new healthcare interventions in a robust way.
A few headline takeaways from the conference this year:
Perspectives on whether it is possible to incorporate environmental factors into HTA decision making without diluting patient-focused outcomes differed. Some stakeholders were particularly concerned that trying to include environmental factors in HTA decision-making would unnecessarily delay patient access to new medicines given the complexity and uncertainty associated with quantifying the environmental impact of new interventions, particularly given that medicines are often manufactured in a different country to where they are ultimately used.
It was suggested that environmental considerations could instead be part of procurement decisions when comparing similar products – products with a more favourable environmental impact should be selected over a treatment with similar efficacy and safety, but poorer environmental outcomes. However, excluding environmental factors from HTA decision-making would mean that environmental benefits are not reflected in the willingness-to-pay threshold for a new intervention (i.e., a price premium), which might otherwise incentivise the development and launch of more environmentally sustainable interventions. An alternative approach may be to incorporate environmental considerations within HTA for only specific types of interventions, such as those being assessed via a cost-comparison approach (based on similar efficacy and safety outcomes) or those with a particularly high carbon footprint (such as asthma inhalers) given environmental considerations are likely to be more influential in these cases.6
The incorporation of environmental considerations into HTA decision-making certainly seems to be gaining traction in some markets; the Netherlands and Canada are looking into the inclusion of environmental considerations within HTA, and NICE are running a HTA Lab on comparing the environmental impacts of health technologies. Considering environmental factors in healthcare decisions sooner rather than later will be particularly important for countries with specific environmental targets, such as the ambitious NHS England targets of net zero carbon emissions by 2045 (for emissions the NHS can influence).7 However, developing robust and consistent frameworks to evaluate the environmental impact of new interventions will be essential to any further progress in this space.
Although several sessions at the conference discussed frameworks that could be used to assess the environmental impact of new healthcare interventions, including the results of a multistakeholder workshop held by the HTA international (HTAi) Environmental Sustainability in Health Technology Assessment (ESHTA) working group, we seem to be far from a consensus on how to accurately and efficiently assess the environmental impact of new interventions.8 Until such frameworks mature and alignment is reached across stakeholders on how to assess environmental impact within HTA, environmental impact is likely to remain an informative input rather than a key decision driver, captured as a complementary input only.9 This will be a key area of focus for the ISPOR SIG for Environmental Assessment in HEOR, and there is likely to be substantial progress on this in the next few years as national and European stakeholders, and the general public, drive a continued focus on assessing environmental sustainability.
Overall, despite many research projects evaluating where and how to best capture the environmental impact of new healthcare interventions over the past few years,8–14 there are several important outstanding questions that must be addressed to define the place of environmental sustainability in HTA decision-making:
The HTAi ESHTA working group are planning a Delphi study to further explore stakeholder opinions on the incorporation of environment sustainability in HTA; the results of this research may help to answer some of these questions and drive further progress in this field.
References
If you would like any further information on the summary presented above, please get in touch, or visit our Value & Access page. Alice Dean (Senior Analyst, Value & Access) and Helen Bewicke-Copley (Consultant, Value & Access) contributed to this article on behalf of Costello Medical. The views/opinions expressed are their own and do not necessarily reflect those of Costello Medical’s clients/affiliated partners.
