Environmental Impact of Intravenous vs. Oral Chemotherapy in France: A 1000-Patient Model-Based Assessment
Author(s)
Lucile Bellier, PharmD, Elsa Duteil, MSc, Rémi Monnier, MSc, Clement LE DISSEZ, PharmD.
PASS, Paris, France.
PASS, Paris, France.
OBJECTIVES: As sustainability becomes a critical component in healthcare delivery, understanding the environmental implications of different administration routes is essential. This study compared the waste production and carbon footprint of intravenous (IV) and oral chemotherapy administered in France.
METHODS: A 6-month treatment pathway was modeled under a standard chemotherapy protocol, comparing IV administration every 3 weeks to daily oral therapy. The evaluation included waste production and carbon emissions (in CO₂e) attributable to patient travel, packaging, medical products (e.g., diluents, disposables), and hospital operations. Input data were sourced from institutional tools and peer-reviewed literature.
RESULTS: For 1,000, IV chemotherapy generated 4.7 tons of waste—including hazardous healthcare waste and 65 tons of CO₂e. In contrast, oral therapy produced 170 kg of waste and 24 tons of CO₂e. This represents a reduction of 4.6 tons of waste and 41 tons of CO₂e, equivalent to the annual carbon footprint of four average French households or approximately 275,000 km driven. These estimates are likely conservative, as they do not account for the environmental impact of active pharmaceutical ingredient (API) manufacturing and relied on a minimalistic approach to IV-related materials and actors, excluding, for instance, the reconstitution phase. In a scenario where oral therapy is dispensed in an ambulatory setting, an additional 62-ton CO₂e reduction is expected by minimizing travel emissions.
CONCLUSIONS: Oral chemotherapy already offers significant environmental advantages over IV administration when delivered in hospitals. Shifting delivery to ambulatory settings could amplify these benefits, supporting more sustainable and efficient care pathways. While chemotherapy serves as the model, these findings more broadly support the expansion of oral regimens when clinically appropriate, aligning ecological performance with therapeutic value.
METHODS: A 6-month treatment pathway was modeled under a standard chemotherapy protocol, comparing IV administration every 3 weeks to daily oral therapy. The evaluation included waste production and carbon emissions (in CO₂e) attributable to patient travel, packaging, medical products (e.g., diluents, disposables), and hospital operations. Input data were sourced from institutional tools and peer-reviewed literature.
RESULTS: For 1,000, IV chemotherapy generated 4.7 tons of waste—including hazardous healthcare waste and 65 tons of CO₂e. In contrast, oral therapy produced 170 kg of waste and 24 tons of CO₂e. This represents a reduction of 4.6 tons of waste and 41 tons of CO₂e, equivalent to the annual carbon footprint of four average French households or approximately 275,000 km driven. These estimates are likely conservative, as they do not account for the environmental impact of active pharmaceutical ingredient (API) manufacturing and relied on a minimalistic approach to IV-related materials and actors, excluding, for instance, the reconstitution phase. In a scenario where oral therapy is dispensed in an ambulatory setting, an additional 62-ton CO₂e reduction is expected by minimizing travel emissions.
CONCLUSIONS: Oral chemotherapy already offers significant environmental advantages over IV administration when delivered in hospitals. Shifting delivery to ambulatory settings could amplify these benefits, supporting more sustainable and efficient care pathways. While chemotherapy serves as the model, these findings more broadly support the expansion of oral regimens when clinically appropriate, aligning ecological performance with therapeutic value.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HSD43
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Organizational Practices
Disease
Oncology