107 - Melissa Pegg on Sustainability in HTA

If we want to fix sustainability in healthcare, one of the most powerful levers sits at the gate where new health technologies get approved: Health Technology Assessment (HTA).

In this episode of the Sustainable Healthcare Podcast, Frederik Dam van Deurs speaks with Melissa Pegg, Senior Research Consultant in Environmental Sustainability in HTA at the York Health Economics Consortium (YHEC), University of York, and co-lead of the first HTAi Working Group on environmental sustainability in HTA.

Disclosure: All opinions are Melissa's own and not the opinions of York Health Economics Consortium (YHEC) and the National Institute for Health and Care Excellence (NICE).

About the guest: Melissa Pegg leads YHEC's environmental sustainability work, bringing environmental impact methods into HTA and health economics for the NHS, government bodies and industry. She holds a master's in HTA (University of Glasgow), spent 18 years in industry before academia, and was a fellow in sustainable surgery for the BMJ.

Three things you'll take away:

• HTA works as a "gatekeeper", and adding environmental impact alongside safety, efficacy and cost could reshape which technologies reach patients.
• - The "information conduit" and "parallel" approaches: getting environmental data into HTA now, reported alongside health-economic data, without waiting for agencies to build new capacity.
• - A real case study with the Scottish Health Technologies Group: reusable vs single-use endoscopes came out around 50% less environmentally impactful, with a more favourable budget impact and QALY, and still held up when the 3,000-use assumption was quartered under sensitivity analysis.

Timestamps:
00:00 Introduction
01:00 Life in York: yoga, two boys, philosophy
03:00 What HTA is, and why it's a gatekeeper
07:00 National vs global: WHO, NICE and the devolved-nation agencies
09:00 The "reference case" and how agencies differ
15:00 Adding the environmental and planetary-health perspective
17:00 Safety for whom? Bringing the environment into the safety domain
22:00 Can it work? The information-conduit approach
24:00 Case study: reusable vs single-use endoscopes with SHTG
30:00 The figures: around 50% lower impact, favourable budget and QALY
33:00 The "just transition" and the classic objections to reusables
39:00 Sensitivity analysis and the 3,000-use assumption
45:00 What makes Melissa hopeful

References mentioned:
Green Surgery report (UK Health Alliance on Climate Change, 2023): https://ukhealthalliance.org/sustainable-healthcare/green-surgery-report/
Cliff Goodman, HTA 101: Introduction to Health Technology Assessment: https://www.inahta.org/wp-content/uploads/2014/09/HTA-101_Goodman_2004.pdf
HTAi Environmental Sustainability in HTA (ESHTA) Working Group: https://htai.org/engage-with-us/working-groups/htai-eshta/
Toward including environmental sustainability in HTA (Cambridge, IJTAHC): https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/toward-including-environmental-sustainability-in-health-technology-assessment/2FF6BA84AC3E7FB280DA2DF3F17D6130
Environmental sustainability in diabetes (Cambridge, IJTAHC): https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/environmental-sustainability-in-diabetes-improving-the-quality-of-diabetes-management-through-hta-and-systemlevel-change/E9B3804A2EB373D31752F6A2587C084A
How Can HTA Shape a More Sustainable Future for Healthcare? (YHEC): https://www.yhec.co.uk/resource/how-can-hta-shape-healthcare-sustainability/
Scottish Health Technologies Group (SHTG): https://shtg.scot/
NICE: https://www.nice.org.uk/

Links:
Melissa Pegg on LinkedIn: https://www.linkedin.com/in/melissapegg1/
Melissa's email: melissa.pegg@york.ac.uk
Melissa's publications (YHEC Environmental Impact): https://www.yhec.co.uk/what-we-do/environmental-impact/
York Health Economics Consortium: https://www.yhec.co.uk/

You might also enjoy:
Episode 103, LCA in Surgery and Specialty-Level Carbon Literacy with Anna Roe Rasmussen: https://carepathwayconsulting.com/podcast/podcast-episode-103/

Host links:
Joachim Almdal on LinkedIn: https://www.linkedin.com/in/joachim-espeland-almdal-017a6973/
Frederik van Deurs on LinkedIn: https://www.linkedin.com/in/frederikvandeurs/
Care Pathway Consulting: https://carepathwayconsulting.com

"HTA is a gatekeeper. The opportunity right now is to get environmental data into HTA and report it alongside everything else, without yet expecting agencies to act on it. That alone would be a huge step forward." - Melissa Pegg