Antonazzo Ippazio Cosimo, Gribaudo Giorgia, Ye Lisa, Ferrara Pietro, Losa Lorenzo, Abrate Paolo, Iraldo Fabio, Mantovani Lorenzo Giovanni, Cortesi Paolo Angelo
Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.
Laboratory of Public Health, Auxologico Research Hospital-IRCCS, Milan, Italy.
Appl Health Econ Health Policy. 2025 Jun 23. doi: 10.1007/s40258-025-00984-7.
Manufacture, distribution, use, excretion, and disposal of health technologies all have environmental impacts (EIs). In the health technology assessment (HTA) definition, EI is recognized as a domain that should be assessed. However, EIs in HTA methods are lacking. The aim of this scoping review was to identify current advances and limitations in incorporating EI in HTA evaluation.
We searched two databases, PubMed and Embase (01/01/2019-20/10/2023, updated on 15/05/2025), using the following keywords: "HTA" and "environmental impact." Articles published in English were included. Additionally, no filters by study design or type of evaluated technology were used.
In total, 264 studies were screened after duplicates had been removed. Among them, 15 articles were included. Identified publications highlighted the necessity of robust and clear methods of EI assessment and its inclusion in the HTA process. Several authors have outlined the importance of assessing the EI of health technology throughout its life cycle, including raw materials, manufacturing, use, and disposal. However, the EI assessment in HTA presents significant challenges, such as determining a clear domain of EI, the perspective, and the time horizon for the assessment. EI assessment challenges also include the lack of disaggregated data on pollutant emissions and natural resource consumption, as well as recommendations on the use of the EI data by decision makers and HTA agencies. In the literature, different methods and approaches have been proposed to incorporate EI in HTA; some rely on already establish assessment methods ("enriched" cost-utility analysis, adjusted willingness to pay, and multicriteria decision analysis) and others proposed more specific approaches, such as "information conduit," "parallel evaluation," "integrated evaluation," and "environment-focused evaluation."
HTA framework needs adjustments to incorporate environmental information, including environmental healthcare technology impact. Clear and robust methods on EI assessment and inclusion in the HTA process should be provided by HTA agencies and international societies. Further, manufacturers should improve the data generation on the EI of their products, with new studies able to generate individual-level data on environmental technology impact.
卫生技术的制造、分销、使用、排泄和处置都会对环境产生影响。在卫生技术评估（HTA）的定义中，环境影响被视为一个应进行评估的领域。然而，HTA方法中缺乏对环境影响的评估。本范围综述的目的是确定在HTA评估中纳入环境影响的当前进展和局限性。
我们使用以下关键词在两个数据库PubMed和Embase（2019年1月1日至2023年10月20日，于2025年5月15日更新）中进行检索：“HTA”和“环境影响”。纳入以英文发表的文章。此外，未按研究设计或评估技术类型进行筛选。
去除重复项后，共筛选出264项研究。其中，纳入了15篇文章。已识别的出版物强调了采用稳健且明确的环境影响评估方法并将其纳入HTA过程的必要性。几位作者概述了在卫生技术的整个生命周期（包括原材料、制造、使用和处置）中评估其环境影响的重要性。然而，HTA中的环境影响评估面临重大挑战，例如确定明确的环境影响领域、评估角度和时间范围。环境影响评估的挑战还包括缺乏关于污染物排放和自然资源消耗的分类数据，以及决策者和HTA机构对环境影响数据使用的建议。在文献中，已经提出了不同的方法和途径将环境影响纳入HTA；一些方法依赖于已有的评估方法（“强化”成本效用分析、调整后的支付意愿和多标准决策分析），而其他方法则提出了更具体的途径，如“信息管道”、“并行评估”、“综合评估”和“以环境为重点的评估”。
HTA框架需要进行调整以纳入环境信息，包括环境对医疗技术的影响。HTA机构和国际社会应提供关于环境影响评估以及将其纳入HTA过程的清晰且稳健的方法。此外，制造商应改进其产品环境影响的数据生成，新的研究应能够生成关于环境技术影响的个体层面数据。
