Methodological Approach to Assess the Environmental Impact Analysis of Expanding Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) in the Chronic Kidney Disease Patient Pathway: A French Perspective
Author(s)
Bruno DETOURNAY, MA, MBA, MSc, MD1, Jean-François Husson, PharmD2, Nathalie Grémaud, PharmD3, Salomé Rabarioelina, PharmD3, Sandrine Bourguignon, MSc, PhD3, Nathalie Camus, .4, Karine Marinier, .4, Clémentine Boulet, .4, Maryvonne Hourmant, MD, PhD5.
1Independent Consultant, Antony, France, 2FHF, Blois, France, 3Rweality, Paris, France, 4AstraZeneca, Courbevoie, France, 5SFNDT, Paris, France.
1Independent Consultant, Antony, France, 2FHF, Blois, France, 3Rweality, Paris, France, 4AstraZeneca, Courbevoie, France, 5SFNDT, Paris, France.
OBJECTIVES: The ecological transition also concerns the healthcare sector, whose emissions account for over 8% of France’s national carbon footprint (Shift Project, 2023). Among long-term renal replacement therapies, hemodialysis is resource-intensive, especially in terms of water, energy, and consumables (SFNDT, 2023). By mechanisms such as reducing end-stage kidney disease incidence, SGLT2i may offer an opportunity to reduce the environmental burden of hemodialysis. This work aims to propose a methodological framework to qualify and quantify the environmental effects associated with the use of SGLT2i in chronic kidney disease (CKD).
METHODS: Our approach combined multiple steps: (1) a review of existing methodologies and databases used in healthcare environmental assessments; (2) a PubMed literature review to identify publications on the environmental and organizational impacts of hemodialysis; (3) a health economic model detailing changes induced by SGLT2i in the CKD care pathway; (4) an expert consultation involving nephrology, health economics, environmental evaluation, and hospital procurement.
RESULTS: Identified methodologies consistently relied on defining the scope for emission analysis, collecting activity data, and applying emission factors. Several relevant emission factor databases were identified. Methodological choices (scope, indicators, data sources, emission factors) were guided by data availability, French national recommendations, and expert consensus. A total of 39 dialysis-related articles were included in the review. Over half of the studies used greenhouse gas emissions and water consumption as key indicators. Waste generation and energy consumption were also reported and can be translated into carbon footprint. In our framework, the environmental impact of SGLT2i was estimated using a static, non-modelled approach, with a time frame defined according to available data. Limitation remains the lack of precise data, requiring assumptions in environmental estimations.
CONCLUSIONS: While reduced hemodialysis incidence with SGLT2i suggests a lower environmental impact in the CKD patient pathway, estimating these effects adds to their clinical and economic value—reinforcing their health system benefits.
METHODS: Our approach combined multiple steps: (1) a review of existing methodologies and databases used in healthcare environmental assessments; (2) a PubMed literature review to identify publications on the environmental and organizational impacts of hemodialysis; (3) a health economic model detailing changes induced by SGLT2i in the CKD care pathway; (4) an expert consultation involving nephrology, health economics, environmental evaluation, and hospital procurement.
RESULTS: Identified methodologies consistently relied on defining the scope for emission analysis, collecting activity data, and applying emission factors. Several relevant emission factor databases were identified. Methodological choices (scope, indicators, data sources, emission factors) were guided by data availability, French national recommendations, and expert consensus. A total of 39 dialysis-related articles were included in the review. Over half of the studies used greenhouse gas emissions and water consumption as key indicators. Waste generation and energy consumption were also reported and can be translated into carbon footprint. In our framework, the environmental impact of SGLT2i was estimated using a static, non-modelled approach, with a time frame defined according to available data. Limitation remains the lack of precise data, requiring assumptions in environmental estimations.
CONCLUSIONS: While reduced hemodialysis incidence with SGLT2i suggests a lower environmental impact in the CKD patient pathway, estimating these effects adds to their clinical and economic value—reinforcing their health system benefits.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH161
Topic
Economic Evaluation, Epidemiology & Public Health, Study Approaches
Topic Subcategory
Public Health
Disease
Urinary/Kidney Disorders