Presentation (CTI)

OBJECTIVES: Sustainability and resource optimisation are gaining priority in reimbursement decisions and hospital policy-making. This analysis examines the workforce burden and environmental impact of administering second-line disease-modifying treatments (DMTs) for relapsing-remitting multiple sclerosis (RRMS) in the Netherlands, comparing personnel time requirements and the estimated carbon footprint across different routes and settings.
METHODS: Data were drawn from the MICRO-MARS study involving patients treated with hospital-based intravenous ocrelizumab or natalizumab, or home-based oral cladribine or subcutaneous ofatumumab. Using a bottom-up micro-costing approach, information was collected through case report forms (covering personnel time, diagnostics, and consumables) and questionnaires (covering travel distance and mode of transport). Personnel time was converted to full-time equivalents (FTEs) to estimate workforce requirements. Environmental impact was assessed by estimating carbon dioxide equivalents (CO₂e) associated with procurement and waste management of consumable medical supplies, diagnostics, hospital building energy use, and travel of personnel, patients and caregivers to hospital or pharmacy. Emission factors were derived from literature and databases. Emissions related to drug production were excluded due to data limitations.
RESULTS: Hospital-based therapies required substantially more personnel time than home-based therapies. Based on typical treatment schedules and a target population of 8,600 patients, treatment administration required an annual FTE needs of 28.74 for natalizumab and 7.37 for ocrelizumab, compared with 2.04 and 0.86 for ofatumumab and cladribine. The per-administration carbon footprint was higher for hospital-based DMTs than for home-based DMTs. Considering the treatment frequencies, the carbon footprint per patient-year was 31.60kg CO₂e for ocrelizumab, 121.62kg for natalizumab, 34.82kg for ofatumumab and 1.39kg for cladribine. Travel was the largest contributor to emissions.
CONCLUSIONS: Home-based DMT administration requires less workforce input and produces lower CO₂e emissions per administration than hospital-based administration. On an annual basis, the workforce advantage remains, but the CO₂e benefit may be offset when accounting for differences in treatment frequency.