OBJECTIVES: The importance of incorporating sustainability into health technology assessments and economic evaluations of new therapies and medical devices has grown in recent years. Validated environmental sustainability (ES) metrics that can be mapped directly to healthcare resource utilization (HCRU) will be crucial to an integrated environmental and economic perspective in these assessments. Thus, we conducted a targeted literature review to determine the availability of existing ES metrics which could serve as inputs in future health economic models.

METHODS: A literature search was conducted using PubMed and Google Scholar to identify papers published in the last 5 years that evaluated ES metrics in health interventions. Search terms included, but were not limited to, "carbon footprint, "greenhouse gas”, "environmental impact," coupled with HCRU and intervention-specific terms such as "diagnostic," "health facilities", “therapeutics, and "healthcare treatment." Google searches were also used to assess the availability of existing datasets offering ES and/or HCRU metrics.

RESULTS: Across the 313 papers identified, 32 articles included ES metrics related to HCRU. Health interventions included surgeries (n=19 studies), dialysis (n=11), anesthesia (n=9), respiratory treatments (n=10), endoscopy (n=7), emergency care (n=7), laparoscopy (n=4), and catheters (n=5). Common ES indicators were carbon footprint (n=28 of studies included CO2 equivalent), waste generation (plastics, drugs, tools; n=7), energy consumption (n=5), water usage (n=4), and certain chemicals (nitrous oxide, isoflurane, propofol; n=3). Additional topics included transport impact, biodiversity, and mineral resource depletion. Studies of health interventions often evaluated multiple ES indicators.

CONCLUSIONS: There is limited published research quantifying the direct environmental impact of health interventions, which may present a barrier to generating comprehensive assessments of ES in healthcare. These findings reinforce the need to develop a consolidated and validated set of ES metrics that can be mapped directly to HCRU and used in future modeling efforts to quantify the sustainability of therapies and medical devices.