Health Technology Assessment and Environmental Impact: A Scoping Review of State of Art and Future Perspective

Ippazio Cosimo Antonazzo, Giorgia Gribaudo (), Lisa Ye, Pietro Ferrara, Lorenzo Losa, Paolo Abrate, Fabio Iraldo, Lorenzo Giovanni Mantovani and Paolo Angelo Cortesi
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Ippazio Cosimo Antonazzo: University of Milan-Bicocca
Giorgia Gribaudo: University of Milan-Bicocca
Lisa Ye: University of Milan-Bicocca
Pietro Ferrara: University of Milan-Bicocca
Lorenzo Losa: University of Milan-Bicocca
Paolo Abrate: Struttura Semplice Continuità Farmaceutica Ospedale-Territorio ASL TO4
Fabio Iraldo: Scuola Superiore Sant’Anna
Lorenzo Giovanni Mantovani: University of Milan-Bicocca
Paolo Angelo Cortesi: University of Milan-Bicocca

Applied Health Economics and Health Policy, 2025, vol. 23, issue 6, No 7, 1027-1038

Abstract: Abstract Introduction 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. Methods 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. Results 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.” Conclusion 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.

Date: 2025
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DOI: 10.1007/s40258-025-00984-7

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