Environmental Impact of Aflibercept for the Treatment of Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema in the Netherlands

OBJECTIVES: Healthcare plays a considerable role in carbon emissions and transitioning towards sustainable practices is essential for achieving climate goals. With the increasing prevalence of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), the use of anti-vascular endothelial growth factor (anti-VEGF) treatments through intravitreal injections has become more common. Each injection of anti-VEGF treatment is estimated to generate 13.68 kg of carbon dioxide equivalent (CO₂eq) and therefore, their regimen strongly impacts the carbon footprint. Aflibercept 8mg allows treatment in extended intervals without compromising efficacy or safety, therefore can contribute a lower burden on the environment.

METHODS: We developed a model to estimate the annual CO₂eq emissions related to treatment with aflibercept 2mg (using an 8-week dosing regimen) and aflibercept 8mg (using a 12-week or 16-week dosing regimen) in the total population of Dutch treatment-naïve nAMD and DME patients, without consideration of market shares. The model incorporated CO₂eq emissions due to patient travel, injection materials, and energy usage.

RESULTS: Switching from aflibercept 2mg to aflibercept 8mg in treatment-naïve nAMD patients lowers the carbon emissions by 11.6% and 24.6% in a 12-week and 16-week dosing regimen, respectively. This reduction translates to an annual decrease of 55,486 and 117,908 CO₂eq in a 12-week and 16-week dosing regimen, respectively. In treatment-naïve DME patients, the switch from aflibercept 2mg to aflibercept 8mg results in an even larger reduction, with carbon emissions decreasing by 26.0% to 36.4%. This decrease corresponds to a reduction of 127,561 (178,585) CO₂eq annually in a 12-week (16-week) regimen.

CONCLUSIONS: Our study shows the substantial impact of the treatment regimens of anti-VEGFs on CO₂eq emissions. Switching from the 8-weekly regimen of aflibercept 2mg to the 12- or 16-week dosing regimen of aflibercept 8mg contributes to the reduction of the carbon footprint within the healthcare system.