Incorporating carbon emissions into health technology assessments


Approximately 4.4% of global greenhouse gas emissions are caused by healthcare. With the increasingly urgent need for the world to decarbonise if it is to meet its 1.5-2°C warming targets, healthcare must play its role. 56 countries have now formally committed to developing low-carbon health systems, with 21 of these committing to net-zero between 2030 and 2050.

There is, however, currently little information on the carbon impacts of specific medical interventions, nor any way for carbon to be included in healthcare assessments. “Both healthcare professionals and health economists are increasingly talking about the importance of including carbon emissions in their decision making. They are looking for concrete actions they can undertake.” said Dr Scott McAlister from the Sydney School of Public Health, lead author of a paper just published in Lancet Planetary Health entitled “Incorporating carbon into health care: adding carbon emissions to health technology assessments”.

This is the first paper to fully investigate how to incorporate carbon emissions quantified by environmental life cycle assessment (LCA) into health technology assessment (HTA). This integration is important, given how HTAs are used extensively for regulatory approvals, and by government organisations and individual public or private payers when making funding decisions. “Deciding which interventions to fund today locks in their carbon emissions going well into the future.” said Dr McAlister.

The paper firstly explains the methodological differences between types of LCA, and their suitability for integration with HTAs, before outlining ways by which quantified carbon emissions could be included in HTAs. Importantly, the paper recognises that HTAs are performed in multiple ways by different jurisdictions, and so provides a framework for emissions to be included as a decision modifier or as one criteria in a multi-criteria decision analysis, or monetised and included as an additional cost in a cost-effectiveness or cost-benefit analysis.

There are a number of technical and implementation challenges to enable the routine incorporation of carbon emissions into HTAs, but these challenges are not unsurmountable. Our paper lays the foundations for meeting these challenges.


Declaration: This study was funded by a National Health and Medical Research Council grant. Dr McAlister received an NHMRC PhD scholarship. Prof Morton received an NHMRC Fellowship.

Dr. Scott McAlister, Wiser Healthcare, The University of Sydney

Prof. Rachael Morton, NHMRC Clinical Trials Centre, The University of Sydney

Prof. Alexandra Barratt, Wiser Healthcare, The University of Sydney