Medicines and devices have significant negative impacts on the environment. Increasingly, Health Technology Assessment (HTA) agencies, which inform healthcare decision making, are expected to integrate environmental issues into their assessments. This study assessed how HTA agencies have responded to these calls, with a focus on two national agencies that have committed to this agenda.

This descriptive study was conducted using document review. All relevant documents from both agencies were systematically collected and analyzed using descriptive statistics and content analysis.

Thirty documents (2015–2024), from Canada’s Drug Agency (CDA) (17) and England’s National Institute for Health and Care Excellence (NICE) (13) that included environmental considerations were analyzed. Although no HTAs have assessed environmental data, primarily due to a lack of data and methods, documents demonstrate that CDA and NICE are employing varied strategies to incorporate environmental considerations through technology guidance. The agencies demonstrate both differences and similarities in approach: NICE focused on carbon and the use phase, whereas CDA focused on multiple environmental impacts across the lifecycle; both agencies are beginning to address the environmental impacts of devices, but there is a notable absence of medicines-related work.

This study demonstrates that the agencies are exploring alternative strategies to elevate attention to the environmental impacts of health technologies. Differences in focus (e.g., whether to prioritize carbon emissions) and shared inattention to medicines point to deeper tensions. Thus, although both agencies have taken important steps forward, much work remains to fully address the environmental harms of health technologies.