PCP5 - THE ECOLOGICAL AND SOCIAL COSTS AND BENEFITS OF INTERVENTIONS – USING THE PRODUCT CARBON FOOTPRINT IN VALUE ASSESSMENT

Abstract

Rising greenhouse gas emissions (GHGEs) are responsible for climate change and have both direct and indirect implications for health. Main drivers for GHGE are the energy industry, agriculture, transport, and households, but healthcare globally contributes approximately 5-8% of total GHGE. The majority of healthcare CO2 emissions come from procurement of goods and services, hospitals and pharmaceutical industry. Some healthcare systems have developed and implemented various strategies to curb healthcare GHGE such as taxation and green public procurement (GPP). However, there are few examples where product-related CO2 burden to society has been quantified; comprehensive “cradle-to-grave” mapping of the product carbon footprint (PCF) expressed as CO2e is the first step to quantify the opportunity for more sustainable healthcare. Priorities may be in high volume indications with routine use of disposable devices, e.g. inhalers. Pressurized metered-dose inhalers (pMDIs) with propellants (HFA) are the most widely used inhalers in COPD and asthma. Although pMDI are less expensive than some other delivery systems, the environmental costs could be considerable. Current value assessment frameworks do not consider ecological benefits and appraisals and thus typically favour low cost delivery systems. The UK NHS reports that propellants from inhalers account for 8% of the NHS’s entire carbon footprint. Globally, 630 million HFA-based pMDIs are used annually resulting in an estimated CO2e burden of 13 million tCO2e, equal to the carbon footprint of 2 mio EU citizens. Assuming a social cost of carbon (SCC) of €40 per tCO2e (SCC values range from 36-220 USD/tCO2e) the value of the CO2 burden would be € 520 mio. Economic Analyses for funding and purchasing decisions may include the monetary value of a more favourable PCF using the social cost of carbon (SCC). Propellant free, re-usable inhalers may save over 90% of tCO2e and SCC by replacing conventional pMDI in Europe.