Parker Gillian, Miller Fiona A
Collaborative Centre for Climate, Health & Sustainable Care, https://ror.org/03dbr7087University of Toronto, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, https://ror.org/03dbr7087University of Toronto, Toronto, ON, Canada.
Int J Technol Assess Health Care. 2025 Jul 21;41(1):e53. doi: 10.1017/S0266462325100366.
Medicines and devices have significant negative impacts on the environment. Increasingly, Health Technology Assessment (HTA) agencies, which inform healthcare decision making, are expected to integrate environmental issues into their assessments. This study assessed how HTA agencies have responded to these calls, with a focus on two national agencies that have committed to this agenda.
This descriptive study was conducted using document review. All relevant documents from both agencies were systematically collected and analyzed using descriptive statistics and content analysis.
Thirty documents (2015-2024), from Canada's Drug Agency (CDA) (17) and England's National Institute for Health and Care Excellence (NICE) (13) that included environmental considerations were analyzed. Although no HTAs have assessed environmental data, primarily due to a lack of data and methods, documents demonstrate that CDA and NICE are employing varied strategies to incorporate environmental considerations through technology guidance. The agencies demonstrate both differences and similarities in approach: NICE focused on carbon and the use phase, whereas CDA focused on multiple environmental impacts across the lifecycle; both agencies are beginning to address the environmental impacts of devices, but there is a notable absence of medicines-related work.
This study demonstrates that the agencies are exploring alternative strategies to elevate attention to the environmental impacts of health technologies. Differences in focus (e.g., whether to prioritize carbon emissions) and shared inattention to medicines point to deeper tensions. Thus, although both agencies have taken important steps forward, much work remains to fully address the environmental harms of health technologies.
药品和医疗器械对环境有重大负面影响。越来越多为医疗保健决策提供信息的卫生技术评估（HTA）机构被期望将环境问题纳入其评估中。本研究评估了HTA机构如何回应这些呼吁，重点关注两个致力于该议程的国家机构。
本描述性研究采用文献综述进行。系统收集了两个机构的所有相关文件，并使用描述性统计和内容分析进行分析。
分析了来自加拿大药品局（CDA）（17份）和英国国家卫生与临床优化研究所（NICE）（13份）的30份包含环境考量的文件（2015 - 2024年）。尽管由于缺乏数据和方法，尚无HTA评估环境数据，但文件表明CDA和NICE正在通过技术指南采用不同策略纳入环境考量。两个机构在方法上既有差异又有相似之处：NICE关注碳排放和使用阶段，而CDA关注整个生命周期的多种环境影响；两个机构都开始关注医疗器械的环境影响，但明显缺乏与药品相关的工作。
本研究表明，这些机构正在探索替代策略，以提高对卫生技术环境影响的关注度。关注点的差异（例如是否优先考虑碳排放）以及对药品的共同忽视表明存在更深层次的矛盾。因此，尽管两个机构都已向前迈出了重要步伐，但要全面解决卫生技术对环境的危害，仍有许多工作要做。
