Exploring Methods to Include Carbon Emissions Into a Health Technology Assessment: The Case of Remote Patient Monitoring

Objectives: 

To examine how 2 methodological approaches can be applied to incorporate environmental outcomes in Health Technology Assessment, using remote patient monitoring (RPM) versus usual care (UC) after cardiac surgery.

Methods: 

We reanalyzed data from an observational cohort (N = 730). Outcomes over 3 months included healthcare utilization, quality of life, patient satisfaction, costs (societal perspective), and carbon emissions, quantified by a life cycle assessment. In extended economic evaluation, emissions were monetized (€0.13/kg CO₂eq; scenario analysis up to €0.21/kg) and added to costs. In multicriteria decision analysis (MCDA), 6 criteria including environmental impact were evaluated with Analytical Hierarchy Process, using stakeholder valuations. 

Results: 

RPM generated higher carbon emissions than UC (90.7 vs 55.4 kg CO₂eq per patient), driven by device production, partly offset by reduced unplanned care, outpatient visits, and patient travel. Despite higher emissions, RPM remained cost-saving (€102 per patient) with a positive incremental net monetary benefit (€42); only 1% of cost difference was attributable to emissions. In the MCDA, RPM outperformed UC in 5 of 6 criteria, with UC only favored on environmental impact. Stakeholders assigned moderate weight to the environmental criterion, resulting in a higher overall value score for RPM (0.649 vs 0.351). 

Conclusions: 

Both methods were feasible and, despite RPM's higher carbon emissions, pointed to the same conclusion. Economic evaluation had little impact at current carbon prices, whereas MCDA allowed explicit sustainability considerations but is sensitive to subjective choices. Overall, environmental outcomes may be better addressed through deliberative Health Technology Assessment processes, with broader policy instruments key to reducing healthcare's carbon emissions.