Challenges and Solutions to Estimating Environmental Impact in Health Technology Assessment
Luke Hubbert, Nina Embleton, Antony Wright, Lindsay Nicholson
Poster Session: 4. 14 November 2023. Poster Session Time: 15:30-18:30. Discussion Period: 16:00-17:00
Abstract
OBJECTIVES: Healthcare has a high environmental cost; the NHS is responsible for 4–5% of the UK carbon footprint. Consequently, environmental impact is gaining importance in decision-making in Health Technology Assessment (HTA), and Life Cycle Assessments (LCAs) can quantify this impact. However, current challenges in conducting LCAs exist, requiring results to be interpreted with caution. The objective of this study was to understand the challenges of conducting and interpratating healthcare LCAs, using a hypothetical example to highlight areas for improvement.
METHODS: A pragmatic literature review was conducted to identify where challenges arise in healthcare LCA. A hypothetical LCA was developed for a single-use/reusable scalpel to illustrate how modelling differences lead to heterogenous results.
RESULTS: Three main categories were identified: data paucity, data comparison, and data interpretation. Data gathering is a key step in LCA, and data can be missing at several points in the process, including in database inventories, healthcare resource usage, or by being proprietary information. Differences in the modelling approach, e.g., definition of intervention, study boundaries, and assumptions made, create difficulty in comparing results. Data interpretation is also challenging, as LCAs produce a variety of different environmental impact categories, each with their own importance that need to be considered. These three issues when simulated in the hypothetical LCA changed whether single-use or reusable scalpels appeared the most environmentally friendly option and created variations in the carbon emissions of up to 37%.
CONCLUSIONS: Reduction in environmental impact is an emerging area in healthcare, and LCAs are necessary to estimate impact and identify ‘hotspot’ areas. This study has identified the challenges associated with valuing impact across studies, including a need for specific healthcare-related database inventories, improvement in data availability and common frameworks. Addressing these challenges is key to ensure accurate and comparable assessments of environmental impacts for use in HTAs.