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Sustainability and Environmental Impact in Market Access and Health Economics

March 24, 2026

As the concept of sustainability gains traction in healthcare, it is beginning to influence how value is assessed and communicated across the Pharmaceutical and Medtech industries. In this article, Helena Grant (Senior Analyst – Global Pricing and Market Access, Petauri Evidence) explores how sustainability considerations are shaping evidence generation, payer expectations, and the future of healthcare innovation.

First published in June 2025, in March 2026 Helena has updated this piece to include new insights, including her reflections on progress in the UK. This follows a webinar where NICE shared the outcomes of an exploration in their HTA Innovation Laboratory looking at how feasible it is to assess the environmental impacts of competing medicines within [1].

Introducing environmental sustainability in market access

We are seeing an increase in the number of requests for evidence and analysis to support environmental impact activities. Leading Pharmaceutical and Medtech companies are including evidence pertaining to sustainability in their evidence dossiers, cost calculations, and value propositions. This is, in part, driven by healthcare providers and payers in key markets who increasingly consider environmental impact and product sustainability in their decision-making processes. The healthcare sector contributes to 1–5% of global greenhouse gas emissions, underscoring the critical need to address energy consumption, transportation, and the lifecycle of medical products [2].

Sustainability in market access involves considering environmental, social, and economic factors of individual innovations and entire care pathways, aiming to reduce the ecological footprint of medicines, technologies, and healthcare processes, while ensuring equitable access to health services. This approach is crucial for the long-term viability of healthcare systems, as it considers greenhouse gas emissions, water usage, biodiversity loss, human rights, and social sustainability.

With payers and healthcare providers in key markets looking to meet new sustainability targets, these factors are of increasing relevance to market access. The sustainability profile of a product can ultimately be a barrier to entry, or a market-winning advantage. There is also growing recognition of the importance of taking a care pathway approach to considering the environmental impact of health interventions. This means going beyond evaluating the environmental impact of a product in isolation, and focusing on the continued environmental impact of the product over time as it is deployed into clinical practice and integrated into the care pathway [3].

We are working with leading Pharmaceutical and Medical Device brands to understand where sustainability impacts their evidence and market access, and drive strategy in the optimal direction. Furthermore, our health economists and statisticians are working with clients to quantify the environmental value of their products, just as they would the clinical and economic value. Our market access teams then work with our clients to incorporate the environmental impact and sustainability value in their proposition and materials, in a way that resonates with a range of stakeholders, spanning clinicians, payers, and health technology assessment (HTA) bodies. To learn more about how we can support you, email evidence@petauri.com.

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Health equity and environmental sustainability

Equity in healthcare means fair access to health services regardless of socioeconomic status. Environmental sustainability focuses on minimising negative environmental impacts. Equity ensures all individuals receive the care they need, while environmental sustainability protects the planet for future generations. Both are essential for a just and sustainable healthcare system.

Demonstrating sustainability to healthcare decision-makers requires transdisciplinary evidence, which is often lacking and challenging to collect. However, existing databases and research can help identify relevant environmental data.

Incorporating environmental sustainability through early value assessments involves quantifying the impact of a medical technology on CO2 emissions, water usage, or waste produced. Early models of a medical technology’s carbon emissions provide valuable insights and enable design tweaks for optimal environmental impact.

Sustainability for HTA submissions

The urgency to reduce environmental impact and its effects on human health has led to calls for HTA bodies to expand their criteria to include environmental effects [4].

Update: In Autumn 2025, we conducted research to explore how global HTA bodies are considering the inclusion of environmental impact into decision making frameworks. Our research found that several countries, including Australia, England, Canada, Denmark, France, , Italy, the Netherlands, and Spain, , have begun or stated an intention to incorporate environmental considerations into formal HTA processes. This indicates that the environmental impact of healthcare technologies is an important value domain to payers and healthcare decision makers. Our research was presented at ISPOR Europe 2025 – download our poster here.

Current initiatives for measuring environmental impact in medicines include environmental risk assessment (ERA) and the Eco-Pharmaco-Stewardship (EPS) initiative [5]. An ERA is performed during the development of new medicines to minimise the release of medicinal byproducts into the environment, identify risk-minimisation activities, and ensure appropriate labelling for disposal. Full environmental Life Cycle Assessments (LCAs) are not currently required for the healthcare sector but are mandated in other industries.

Update: Publication of PAS2090: A significant recent shift that will further support the consistent reporting and appraisal of the environmental impact of pharmaceutical products is the new PAS2090 standard. The standard, published by the British Standards Institution (BSI) in December 2025 is the first global standard for conducting product-level LCAs. The creation of a common framework will enable the reporting of environmental impacts of drug products to be standardised and compared. NICE, in England, also used the standard to inform its proposed approach to incorporating environmental value in HTA (6, 7) (see more below).

As HTA bodies globally begin to focus on sustainability aspects of new healthcare technologies, Pharmaceutical and Medical Device companies need to be clear on the environmental value of their products. This includes assessing the evidence that they currently have and the evidence they need to generate to address healthcare system priorities.

Pharmaceutical and Medtech companies should also plan how they will communicate the environmental value of new technologies in a format that resonates with decision-makers, such as through value propositions. These are areas where Petauri Evidence can help.

Local procurement requirements around sustainability

Whilst local markets all have their own environmental policies, many are looking to the UK as an example. The National Health Service (NHS) in England is committed to reaching net zero for its carbon footprint by 2040, with an 80% reduction of direct emissions by 2032 [8].

To achieve this ambition, from April 2027, all suppliers must publicly report targets, emissions, and a Carbon Reduction Plan for global emissions aligned to the NHS net zero target, for all Scope 1 (direct facilities and vehicles), 2 (indirect/purchased amenities, e.g. electricity) and 3 emissions (indirect from upstream and downstream supply chains). Additionally, from April 2028, new requirements will be introduced that require manufacturers to report carbon footprint information for all individual products supplied to the NHS. From 2030, suppliers will only be able to qualify for NHS contracts if they can demonstrate progress towards net zero via published progress reports and continued carbon emissions (9).

Nordic countries are also leading on sustainable procurement initiatives. There have been examples where tenders have been awarded on environmental sustainability criteria, rather than price [10]. As such, it is important that global market access teams explore the environmental value of products and gather relevant evidence, as this may be a key element in local value propositions in some markets.

International standards from the World Health Organization (WHO) and International Organization for Standardization (ISO) provide guidelines for incorporating sustainability into healthcare [11]. These standards help align procurement practices with global sustainability goals. In many markets, sustainable healthcare is (at last!) becoming increasingly important in procurement and decision-making.

Health economic modelling and early-stage carbon impact modelling

Purchasing bodies want to see that the potential environmental impact of a technology or medication has been considered. We can use both quantitative and qualitative methods to calculate and demonstrate this impact.

The first step is to set the boundaries of the evaluation and be transparent about what steps are included and excluded.

When evaluating the carbon impact of a new medical technology, we need to consider a variety of factors. This includes the sourcing of raw materials, the refining process, transportation, manufacturing, assembly, and storage. The product’s use and disposal will also generate a carbon footprint. Multi-use items may reduce carbon per use but require additional processing and sterilisation. Recycling can reduce environmental impact but may not always be possible for biohazardous medical components. All of these elements must be factored into our calculations.

There are a number of different modelling techniques that we can utilise depending on the product and its place in the treatment pathway. We often recommend an early-stage carbon impact model, which quantifies the impact of a medical technology on CO2 emissions. We would also recommend including a sensitivity analysis for a comprehensive evaluation.

Study support and statistical analysis of environmental impact

Real-world data on the carbon impact of a technology are crucial for building a compelling environmental value proposition. Studies exploring this should measure both direct and indirect environmental impacts. Statistical methods, such as regression and multivariate analysis, can analyse the impact of sustainability initiatives and quantify the relationship between sustainability efforts and health outcomes.

The care pathway approach to measuring environmental value

Whilst life cycle assessments from the point of manufacture to disposal are important for quantifying the environmental impact of individual products, the environmental value of new technologies can be enhanced by considering how the technology will continue to impact the environment as it is integrated into clinical pathways and routine clinical use [3].

Environmental value can be seen as a component of high-value care that contributes to improved patient outcomes and population health. Considering the environmental impact of technologies across the entire clinical pathway enables us to benefit from the synergies between patient outcomes and environmental outcomes. For example, a new technology may be able to prevent resource-intensive, long-term complications that are associated with a higher carbon footprint. Taking a care pathway approach quantifies this additional environmental and clinical value. Initiatives are underway to develop standardised methodologies to scale the care pathway approach and accelerate the impact of environmentally valuable health technologies [3].

Challenges and opportunities with sustainability in market access

Barriers to integrating sustainability in market access include limited data availability, lack of standardised metrics, and resistance to change. Addressing these barriers requires collaboration and innovation. Industry collaboration on sustainability, reporting of greenhouse gas footprints, partnering with healthcare providers on waste, investing in green innovation, and creating incentives for sustainability in procurement are essential steps [12].

There is an opportunity for the Pharmaceutical and Medical Devices industries to lead in advocating for policy changes, investing in sustainability research and knowledge sharing, and promoting education and awareness. These actions can drive progress toward a more sustainable healthcare system.

New: Update on NICE’s progress as of February 2026

In February 2026, NICE hosted a webinar to share an update on their progress towards formally including environmental criteria into their HTA methods (1). The webinar hosts presented findings from their experimental HTA lab project – a collaboration between NICE, industry, and an external assessment group (EAG), with the following aims:

  • To pilot a draft submission form for collecting environmental data
  • To test the feasibility for manufacturers to collect and submit this information based on a real product
  • To gain an independent appraisal and critique of the data, and an assessment of suitability of the draft form for informing future HTA decisions (via the EAG)

In the webinar, the Pharmaceutical company and EAG were positive about the strengths of the proposed process in enabling the systematic collection of environmental data in a way that fits in alongside existing HTA processes. However, the EAG concluded that the mock evidence submission approach in its current form is insufficient for NICE’s decision making. The following sections outline the key challenges faced, and what needs to happen to enable further progress.

Data limitations

Manufacturers typically cannot access data on competitor LCAs to inform comparative assessments, which are essential if environmental considerations are to be used to assess the trade-offs between two technologies. There is potential for this to be addressed by a centralised database in the future.

The care pathway approach

LCAs only capture product-specific impacts, whereas NICE and the NHS may be more interested in the downstream environmental impacts of the technology once it is introduced into the healthcare system. A standardised care pathway approach is needed to ensure comparability.

How environmental data will factor into NICE’s final decision

NICE also do not yet know how environmental information, once submitted and appraised, will actually inform reimbursement or guideline decisions. It is likely that a pragmatic and proportional approach will be used that focuses on products with the greatest potential for environmental impact, rather than an assessment for every new technology.

Evidence standards

The webinar also raised some key unknowns around the evidence standards for an environmental submission, including how the quality of LCAs will be assessed, whether environmental evidence from other geographies is acceptable, and which evidence smaller manufacturers should prioritise.

The webinar hosts suggested that any future submission template will likely centre around the PAS 2090 standard and product carbon footprints in the first instance to align with immediate NHS priorities.

Key takeaways from NICE’s webinar:

  • Sustainability will not be incorporated into NICE HTA or reimbursement decisions in the near term
  • A standardised care‑pathway modelling method and a central data resource are essential before environmental data can meaningfully inform treatment decisions
  • The overall approach needs further development, including solutions to current data‑sharing constraints
  • For now, NICE and the NHS are using post‑reimbursement levers to reduce environmental impact, such as the green inhalers initiative
  • Next steps may align with the NHS plan to require carbon‑footprint data for all products by 2028, although the scope and methodology are still to be defined

Moving forward with sustainability

Integrating sustainability into healthcare practices is essential for addressing the environmental and social challenges of the 21st century. By working together, stakeholders can ensure healthcare practices contribute to a healthier planet and improved health outcomes for all. Leading Pharmaceutical and Medtech companies are putting sustainability at the top of their agenda, which is not only good for the environment but also helps achieve market access goals. Manufacturers can begin their journey toward supporting healthcare system sustainability through their market access activities.

We are working with leading Pharmaceutical and Medical Device brands to understand where sustainability impacts their evidence and market access, and drive strategy in the optimal direction. Furthermore, our health economists and statisticians are working with clients to quantify the environmental value of their products, just as they would the clinical and economic value. Our market access teams then work with our clients to incorporate environmental impact and sustainability value in their propositions and materials, in a way that resonates with a range of stakeholders, spanning clinicians, payers, and HTA bodies. Our clients are increasingly seeing the market advantage of these efforts:

“The value document developed to highlight our sustainability efforts is a key differentiator for us, making us the only company in our field with such a comprehensive resource. It supports a wide range of activities – government engagement, tenders, congresses, and key opinion leader meetings – and is particularly valuable in winning accounts.” – Market Access Manager, Top 20 Medtech Company

To explore the environmental value of your products and how sustainability can be a key advantage in your propositions, email evidence@petauri.com.

References:

  1. National Institute for Health and Care Excellence. HTA Lab projects. Available from: https://www.nice.org.uk/what-nice-does/our-research-work/hta-lab/hta-lab-projects. Accessed on: March 2026.
  2. Lenzen M, Malik A, Li M, Fry J, Weisz H, Pichler PP, et al. The environmental footprint of health care: a global assessment. Lancet Planet Health. 2020;4(7):e271-e9.
  3. Sustainable Healthcare Coalition. Building environmental considerations into the evaluation of health interventions. 2025. Available from: https://shcoalition.org/wp-content/uploads/2025/02/Building-environmental-considerations-into-the-evaluation-of-health-interventions-Taking-a-care-pathway-approach.pdf. Accessed on: June 2025.
  4. Marsh K, Ganz ML, Hsu J, Strandberg-Larsen M, Gonzalez RP, Lund N. Expanding Health Technology Assessments to Include Effects on the Environment. Value Health. 2016;19(2):249-54.
  5. AESGP. The Eco-Pharmaco-Stewardship. Available from: https://aesgp.eu/eco-pharmaco-stewardship. Accessed on: February 2025.
  6. European Pharmaceutical Review. BSI launches a world-first environmental standard for the pharma industry. 2025. Available from: https://www.europeanpharmaceuticalreview.com/news/268345/bsi-pas-2090-environmental-standard-pharmaceutical-industry/. Accessed on: March 2026.
  7. Quantis. What PAS 2090 Means for the Future of Sustainable Pharma 2025. Available from: https://quantis.com/news/what-pas-2090-means-for-the-future-of-sustainable-pharma/. Accessed on: March 2026.
  8. NHS England. Delivering a net zero NHS. Available from: https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/. Accessed on: February 2025.
  9. NHS England. Greener NHS – Suppliers. Available from: https://www.england.nhs.uk/greenernhs/get-involved/suppliers/. Accessed on: March 2026.
  10. Amgros. Suppliers strongly support joint Nordic tendering procedures. 2024. Available from: https://amgros.dk/about-amgros/news/suppliers-strongly-support-joint-nordic-tendering-procedures. Accessed on: February 2025.
  11. World Health Organization. Environmentally sustainable health systems: a strategic document. Available from: https://iris.who.int/bitstream/handle/10665/340375/WHO-EURO-2017-2241-41996-57723-eng.pdf. Accessed on: February 2025.
  12. Firth I, Hitch J, Henderson N, Cookson G. Moving towards a more environmentally sustainable pharmaceutical industry: recommendations for industry and the transition to green HTA. Expert Rev Pharmacoecon Outcomes Res. 2023;23(6):591-5.

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