Presentation (CTI)

OBJECTIVES: Pressurised metered-dose inhalers (pMDIs) are a cornerstone of respiratory treatment but contribute substantially to greenhouse gas (GHG) emissions. As health systems chase net zero targets, pMDIs reformulated with low global warming potential (GWP) propellants offer an alternative. This study quantifies the environmental and economic value of transitioning to low-GWP propellant pMDIs for asthma treatment across six European countries, leveraging ISPOR's concept of Whole Health by broadening assessment beyond traditional clinical and cost dimensions.
METHODS: An integrated evaluation framework was applied to estimate CO₂ equivalent (CO₂e) reductions from transitioning from standard pMDI to three case study low-GWP propellant pMDI regimens (ICS; ICS/LABA; ICS/LABA/LAMA) for treatment of asthma, in France, Germany, Italy, the Netherlands, Spain, and the United Kingdom. Therapeutic equivalence between existing and low-GWP propellant pMDIs was assumed based on published pharmacokinetic and safety evidence. CO₂e savings were converted to monetary values using country-specific carbon prices and to disability-adjusted life years (DALYs) using published health damage factors. Primary analyses were conducted at the per-patient (annual and lifetime) level, with secondary indicative multi-indication analyses conducted at the national level.
RESULTS: Transitioning to low-GWP propellant pMDIs reduced per-patient carbon emissions by approximately 88%, saving 90-132 kg CO₂e per patient annually, depending on the product used. Monetised savings ranged from €18-€117 per patient per year, and €457-€2,906 over a lifetime (discounted), with substantial variation driven by country-specific carbon valuation. Multi-indication population-level analyses suggest full transition could avert 33-415 million kg CO₂e annually across the six countries. DALY analyses demonstrated consistent global health gains.
CONCLUSIONS: Low-GWP propellant pMDIs can deliver environmental and economic benefits while preserving clinical outcomes. Environmental impacts, a key contributor to individuals’ and societal wellbeing under the concept of Whole Health, can be captured within economic analyses, but debate continues about the utility of using this data within health technology assessment.