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Green metrics in health technology assessments

The Athena Institute has analysed together with the Dutch National Health Care Institute in what ways ‘Green Metrics’ can become part of health technology assessment and can play a part in decisions on reimbursement of new medical devices, like medicines.

Climate change due to human activity and its risks to human health are well known. In healthcare, there is increasing attention to the climate and environmental impacts of the use of medical and health technologies. In health technology assessment (HTA), there is an increasing need for outcome measures that take the environmental impact of medical interventions into account (i.e. green metrics) in addition to clinical utility, effectiveness, efficiency or satisfaction. However, it is still unclear which researchers and HTA organisations are already working on this sustainability dimension, in what way and what they have achieved so far. Moreover, the complex relationships between the climate crisis, environmental pollution, health and healthcare are difficult to trace, and methods are scarce.

Objectives and approach
To explore the status of development and application of green metrics by international research groups and HTA organisations we started with a mapping review and built on that through snowballing, interviews with HTA and non-HTA experts involved in sustainability and health care, and concluded with a survey on preferences and feasibility issues by HTA experts on regarding possible incorporation of green metrics into HTA.

Lessons and outcomes
Although the research is still ongoing, the results till now show that there is an increasing number of experiments with ‘green metrics’, and there are some (non-standardised) approaches, tools and methods for assessment available. Furthermore, there are a couple of examples of assessments on product level which can be used in valuation processes in HTA. Currently, generics are the ‘low hanging fruit’ of developing ‘green metrics’. However, more (reliable) data on product level is needed. Furthermore, valid and suitable approaches for assessment and valuation that have a fit with HTA-processes are scarce. To further the inclusion of ‘green metrics’, health policies should create a mandate for HTA organisations to include these metrics in valuation processes. More detailed results will be published soon.

Project details