QUANTIFYING THE ENVIRONMENTAL BURDEN OF LIPOPROTEIN APHERESIS IN HOMOZYGOUS FAMILIAL HYPERCHOLESTEROLAEMIA
Author(s)
Khashayar Azimpour, MD, PhD1, Laura Cornic, MSc, PharmD2, Patricia Causse Safar, MD3, Chiara Obici, MSc4, Andrea Panico, PhD4, Phil Dawson, BSc5, Luke Hubbert, MMath6, Cheryl Jones, BSc, MSc, PhD6, Lindsay Nicholson, PhD6, Andrew Briggs, DPhil7.
1Chiesi Canada Corporation, Woodbridge, ON, Canada, 2Chiesi Farmaceutici S.p.A, Île-de-France, France, 3Chiesi France S.A.S., Bois–Colombes, France, 4Global Rare Diseases, Chiesi Farmaceutici S.p.A., Parma, Italy, 5Chiesi UK Ltd, Manchester, United Kingdom, 6Maverex Limited, Newcastle upon Tyne, United Kingdom, 7Global Health Economics Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom.
1Chiesi Canada Corporation, Woodbridge, ON, Canada, 2Chiesi Farmaceutici S.p.A, Île-de-France, France, 3Chiesi France S.A.S., Bois–Colombes, France, 4Global Rare Diseases, Chiesi Farmaceutici S.p.A., Parma, Italy, 5Chiesi UK Ltd, Manchester, United Kingdom, 6Maverex Limited, Newcastle upon Tyne, United Kingdom, 7Global Health Economics Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom.
OBJECTIVES: Homozygous familial hypercholesterolaemia (HoFH) is a rare genetic disorder characterised by elevated low‑density lipoprotein cholesterol (LDL-C) from birth, causing early atherosclerotic cardiovascular disease and premature mortality. LDL apheresis effectively lowers LDL-C but requires lifelong, repeated, and invasive treatment. Lomitapide inhibits microsomal triglyceride transfer protein, reducing LDL-C production; published studies report associated reductions in LDL apheresis frequency or discontinuation. The environmental implications of these changes remain unquantified. This study estimated greenhouse gas (GHG) emissions for LDL apheresis in Italy and the UK, and explored emission reductions under lomitapide-informed apheresis-reduction scenarios.
METHODS: An ISO 14040/44‑compliant life‑cycle assessment estimated GHG emissions from LDL apheresis in Italy and the UK. Functional units were kg CO₂e per apheresis session and per patient‑year. The system boundary included patient travel to apheresis centres and on‑site energy use; single-use consumables were excluded and will be included in a future scenario. Country‑specific inputs were mapped to ecoinvent and characterised using ReCiPe 2016 climate change indicator. Emissions were estimated for a base case (0.96 sessions/week; 227 treated patients in Italy; 66 in the UK) and lomitapide-informed reduced-frequency scenarios (22-70%), informed by published data.
RESULTS: Base‑case emissions were 41.9kg and 61.8kg CO₂e per session in Italy and the UK, respectively. Annual emissions were 2,090kg CO₂e per patient and 475,000kg CO₂e at the population level in Italy, and 3,090 and 204,000kg CO₂e in the UK. Lomitapide-informed reductions in apheresis frequency indicate lower per-patient emissions of 624-2,410kg CO₂e. Transport was the dominant contributor in both settings.
CONCLUSIONS: LDL apheresis in HoFH was associated with quantifiable GHG emissions. Population-level emissions corresponded to ~1.2 million and ~0.5 million kilometres driven by a petrol car in Italy and the UK, respectively. Exploratory modelling suggests that reduced apheresis frequency may lower apheresis-related emissions through reductions in resource utilisation and travel. These findings provide GHG emission estimates for LDL apheresis.
METHODS: An ISO 14040/44‑compliant life‑cycle assessment estimated GHG emissions from LDL apheresis in Italy and the UK. Functional units were kg CO₂e per apheresis session and per patient‑year. The system boundary included patient travel to apheresis centres and on‑site energy use; single-use consumables were excluded and will be included in a future scenario. Country‑specific inputs were mapped to ecoinvent and characterised using ReCiPe 2016 climate change indicator. Emissions were estimated for a base case (0.96 sessions/week; 227 treated patients in Italy; 66 in the UK) and lomitapide-informed reduced-frequency scenarios (22-70%), informed by published data.
RESULTS: Base‑case emissions were 41.9kg and 61.8kg CO₂e per session in Italy and the UK, respectively. Annual emissions were 2,090kg CO₂e per patient and 475,000kg CO₂e at the population level in Italy, and 3,090 and 204,000kg CO₂e in the UK. Lomitapide-informed reductions in apheresis frequency indicate lower per-patient emissions of 624-2,410kg CO₂e. Transport was the dominant contributor in both settings.
CONCLUSIONS: LDL apheresis in HoFH was associated with quantifiable GHG emissions. Population-level emissions corresponded to ~1.2 million and ~0.5 million kilometres driven by a petrol car in Italy and the UK, respectively. Exploratory modelling suggests that reduced apheresis frequency may lower apheresis-related emissions through reductions in resource utilisation and travel. These findings provide GHG emission estimates for LDL apheresis.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD28
Topic
Economic Evaluation, Health Service Delivery & Process of Care
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)