Integrating Planetary Health in Health Technology Assessment: principles and challenges

Abstract Planetary health is emerging as a crucial element when assessing health technologies, advocating for a transformative shift towards systems thinking to integrate environmental considerations and prioritize ‘Planetary health for all.’ This perspective recognises and suggests that the inclusion of a planetary health domain into Health Technology Assessment (HTA) can significantly enhance decision-making in health systems and contribute to addressing the Triple Planetary Crisis. By evaluating technologies and interventions based on their environmental impact alongside clinical and cost outcomes, health systems can make more informed choices. However, the latest EU HTA regulation does not emphasize planetary health, and only a few HTA bodies, such as France's Haute Authorité de Santé, the UK's NICE, and the Dutch National Health Care Institute (ZIN), have begun to consider incorporating these aspects into their strategies and case studies. There is an urgent need for a coordinated European response to address several key challenges, including the absence of standardized methodologies due to a lack of uniform guidelines for assessing environmental impacts within HTAs, the limited access to comprehensive environmental data relevant to healthcare technologies, or the quantification of indirect effects like supply chain emissions. Integrating environmental impact metrics with traditional economic evaluations, such as cost-effectiveness analyses, poses challenges due to the lack of frameworks to balance environmental benefits against economic costs. Furthermore, there is limited awareness and expertise among HTA practitioners regarding environmental assessment methods, highlighting the need for updated education and transdisciplinary collaboration to improve understanding and implementation. To move forward, concrete steps must be taken to embed environmental considerations onto HTA processes and ensure these become standard practice in Europe.