Impact of Nonclinically Driven Inhaler Initiation or Switch on Carbon (CO2) Emissions and Healthcare Costs for COPD Patients Using Single-Inhaler Triple Therapy (SITT)
Author(s)
Krishnali Parsekar, M.Sc1, Georgios Xydopoulos, PhD2, Abdelhamid Yousef, -2, George Agathangelou, PhD2, Richard John Fordham, PhD3, Magnus Köping-Höggård, -4, Jonathan Marshall, PhD1, Dorthe Petersen, -5, Isabella Rustignoli, MSc6, Juan Fernando Soto Barrientos, M.Sc7, Deniz Tansey-Dwyer, M.Sc1, John Bell, Dr1, Omar Usmani, Dr8.
1AstraZeneca, Cambridge, United Kingdom, 2ZS Associates, Cambridge, United Kingdom, 3University of East Anglia, Norwich, United Kingdom, 4AstraZeneca, Stockholm, Sweden, 5AstraZeneca, Copenhagen, Denmark, 6Alexion Pharma, London, United Kingdom, 7AstraZeneca, London, United Kingdom, 8Imperial College London, London, United Kingdom.
1AstraZeneca, Cambridge, United Kingdom, 2ZS Associates, Cambridge, United Kingdom, 3University of East Anglia, Norwich, United Kingdom, 4AstraZeneca, Stockholm, Sweden, 5AstraZeneca, Copenhagen, Denmark, 6Alexion Pharma, London, United Kingdom, 7AstraZeneca, London, United Kingdom, 8Imperial College London, London, United Kingdom.
OBJECTIVES: Although <0.04% of global greenhouse gas emissions are attributed to pressurised metered dose inhalers (pMDIs), efforts to reduce CO2e (carbon dioxide equivalent) emissions from some health systems might lead to non-clinically driven initiation or switch to dry powder inhalers (DPIs) over pMDIs which could have variable consequences. The objective was to assess CO2e emission and cost impact of non-clinically driven inhaler initiation/switch to DPIs due to environmental concerns within SITT class for COPD patients in UK, Sweden and Denmark.
METHODS: A targeted literature review informed a cost and CO2e budget impact model. Sensitivity analyses explored parameter variations, and additional analysis examined the impact of introducing pMDIs with next-generation propellants (NGPs) from 2026.
RESULTS: Environmentally driven inhaler policies from 2024-2028 yielded lower than anticipated CO2e savings (metric tonnes of CO2e [kg CO2e]: UK=-15,400, Sweden=-824.6, Denmark=-384 kg CO2e) and increased healthcare costs (UK=£563.5 million; Sweden=-€37.4 million; Denmark=€30.3 million). Higher CO2e emissions related to COPD exacerbations offset approximately 65-70% of the anticipated inhaler-related savings. Furthermore, continuing these policies after the introduction of pMDIs with NGPs completely negated CO2e savings, resulting in a 12 to 13-fold increase in total CO2e emissions noting TRIXEO/BREZTRI with the next-generation propellant already being approved by UK Medicines and Healthcare Products Regulatory Agency as of 2025.
CONCLUSIONS: Non-clinically driven SITT initiation or switching policies to DPIs may initially appear to offer CO2e emission savings, but these benefits are largely offset by increased emissions from poorer clinical control and healthcare resource utilization. Policies and guidelines encouraging a preferred DPI initiation or switch for environmental reasons should be updated to account for pMDIs with NGP, which have similar greenhouse gas (GHG) footprint to DPIs. Optimal COPD management through evidence-based guidelines and appropriate device selection is crucial to balance minimizing carbon footprint and healthcare resource utilization with improving patient outcomes.
METHODS: A targeted literature review informed a cost and CO2e budget impact model. Sensitivity analyses explored parameter variations, and additional analysis examined the impact of introducing pMDIs with next-generation propellants (NGPs) from 2026.
RESULTS: Environmentally driven inhaler policies from 2024-2028 yielded lower than anticipated CO2e savings (metric tonnes of CO2e [kg CO2e]: UK=-15,400, Sweden=-824.6, Denmark=-384 kg CO2e) and increased healthcare costs (UK=£563.5 million; Sweden=-€37.4 million; Denmark=€30.3 million). Higher CO2e emissions related to COPD exacerbations offset approximately 65-70% of the anticipated inhaler-related savings. Furthermore, continuing these policies after the introduction of pMDIs with NGPs completely negated CO2e savings, resulting in a 12 to 13-fold increase in total CO2e emissions noting TRIXEO/BREZTRI with the next-generation propellant already being approved by UK Medicines and Healthcare Products Regulatory Agency as of 2025.
CONCLUSIONS: Non-clinically driven SITT initiation or switching policies to DPIs may initially appear to offer CO2e emission savings, but these benefits are largely offset by increased emissions from poorer clinical control and healthcare resource utilization. Policies and guidelines encouraging a preferred DPI initiation or switch for environmental reasons should be updated to account for pMDIs with NGP, which have similar greenhouse gas (GHG) footprint to DPIs. Optimal COPD management through evidence-based guidelines and appropriate device selection is crucial to balance minimizing carbon footprint and healthcare resource utilization with improving patient outcomes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE539
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Budget Impact Analysis
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)