Adapting Health Economic Evaluation Metrics to Incorporate Estimates of Environmental Impact: An Examination of Spinal Laminectomy and Fusion Procedures in Canada

Abstract

Climate change is an urgent threat to public health, yet healthcare contributes substantially to environmental damage. This thesis explores how environmental impacts can be incorporated into health economic evaluations to support sustainable healthcare decision-making. A narrative review synthesized literature on ecological economics, planetary health, and sustainable healthcare to identify key themes relevant to health technology assessment. An empirical analysis examined the environmental footprint of a common surgical procedure, using real-world data to estimate emissions and explore opportunities for reduction. While environmental costs were small relative to total healthcare costs, they revealed where emissions are concentrated, and which aspects of care may be more easily changed. Patient travel emerged as a key contributor and a target for low-disruption reductions. By combining conceptual insights with practical analysis, this work demonstrates how environmental costs can be integrated into healthcare evaluation frameworks, helping healthcare systems align service delivery with broader climate and sustainability goals.