A source of debate among the health technology assessment (HTA) community is what perspective should be taken in health economic evaluations. Many stakeholders advocate that a societal perspective is taken in order to include a comprehensive range of costs and outcomes and (in theory) make societally optimal decisions. The Second Panel on Cost-Effectiveness in Health and Medicine recommended that a societal perspective be presented alongside a health sector one. The Second Panel included environment as one item on its impact inventory—alongside productivity, education, and others—intended to support the use of a societal perspective. However, many HTA agencies, including the National Institute for Health and Care Excellence (NICE), have continued to use health sector-specific evaluations to inform decision-making. The presentation seeks to examine whether consideration of the environmental impact of healthcare requires/implies the formal adoption of a societal perspective in health economic analyses.

The presentation will provide an overview of the societal perspective, explaining how it differs from a health sector perspective and describing its main strengths and weaknesses. We then present policy analysis undertaken by NICE’s Science Policy and Research team to identify reasons for measuring environmental impact in HTAs and examine whether these align with the broader arguments for or against adopting a societal perspective in economic analyses.

Three reasons for considering environmental impact are identified: (i) to support parallel policies which demand healthcare system transformation against emissions targets; (ii) to ensure planetary and human health, in the future as well as the present; and (iii) to offset future healthcare resource use. We show that only the third reason aligns with arguments related to the choice of perspective for economic analyses. Moreover, this reason is arguably better aligned to maintaining a (potentially modified) health sector perspective. The implications of the results will be discussed with reference to updating reimbursement decision-making frameworks, such as those used by NICE, to account for the environmental consequences of healthcare.