A BOTTOM-UP RESOURCE USE INVENTORY OF CONTRAST-ENHANCED MAMMOGRAPHY TO SUPPORT ENVIRONMENTAL SUSTAINABILITY IN HEALTH TECHNOLOGY ASSESSMENT
Author(s)
Nataša Peric, Dr1, Clemens Österle, MSc2, Paola Clauser, Dr3, Pascal Baltzer, Prof. Dr.3, Michael Schwingshackl, Mag4.
1Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria, 2Abfallbeauftragtenteam, VAMED KMB, Vienna, Austria, 3Department of Biomedical Imaging and Image-guided Treatment, Medical University of Vienna, Vienna, Austria, 4Department Ecotoxicology & Environmental Management, UAS Technikum Wien, Vienna, Austria.
1Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria, 2Abfallbeauftragtenteam, VAMED KMB, Vienna, Austria, 3Department of Biomedical Imaging and Image-guided Treatment, Medical University of Vienna, Vienna, Austria, 4Department Ecotoxicology & Environmental Management, UAS Technikum Wien, Vienna, Austria.
OBJECTIVES: Health technology assessment (HTA) agencies are looking at how to include environmental sustainability in their evaluations. A major challenge is the lack of process-based resource use data. Contrast-enhanced mammography (CEM) is a new diagnostic option compared to standard mammography and MRI for women with dense breasts. To provide the essential data needed for extended economic evaluations, we created a detailed resource use inventory of the CEM clinical pathway.
METHODS: We conducted a cradle-to-grave life cycle assessment at an Austrian university hospital following ISO 14040/44 guidelines. The functional unit was one bilateral breast examination. We collected primary data on-site by weighing single-use consumables, surveying patient travel, and measuring equipment energy use. We supplemented this data from literature for power profiles and the Ecoinvent 3.11 database for background processes. We reported greenhouse gas (GHG) emissions in kilograms of carbon dioxide equivalents (kg CO2e) and assessed parameter uncertainty through deterministic scenario analyses.
RESULTS: When separating the clinical procedure from patient mobility, standard mammography emits 2.8 kg CO2e, whereas a CEM examination emits 7.7 kg CO2e. This additional footprint of 4.9 kg CO2e mainly comes from single-use plastic syringes and iodinated contrast media. When including patient travel, the total footprint of CEM rises to 16.4 kg CO2e. The energy analysis also showed that the imaging equipment uses almost 90% of its power during standby periods rather than during active scans.
CONCLUSIONS: This bottom-up inventory provides the necessary parameters to incorporate the climate impact of CEM into standard cost-effectiveness models. Because the social cost of carbon (SCC) varies across regions, providing raw physical data allows health economists to apply the SCC specific to their context. Finally, even though CEM emits more GHG than standard mammography, it provides a carbon-efficient alternative to MRI without compromising diagnostic performance.
METHODS: We conducted a cradle-to-grave life cycle assessment at an Austrian university hospital following ISO 14040/44 guidelines. The functional unit was one bilateral breast examination. We collected primary data on-site by weighing single-use consumables, surveying patient travel, and measuring equipment energy use. We supplemented this data from literature for power profiles and the Ecoinvent 3.11 database for background processes. We reported greenhouse gas (GHG) emissions in kilograms of carbon dioxide equivalents (kg CO2e) and assessed parameter uncertainty through deterministic scenario analyses.
RESULTS: When separating the clinical procedure from patient mobility, standard mammography emits 2.8 kg CO2e, whereas a CEM examination emits 7.7 kg CO2e. This additional footprint of 4.9 kg CO2e mainly comes from single-use plastic syringes and iodinated contrast media. When including patient travel, the total footprint of CEM rises to 16.4 kg CO2e. The energy analysis also showed that the imaging equipment uses almost 90% of its power during standby periods rather than during active scans.
CONCLUSIONS: This bottom-up inventory provides the necessary parameters to incorporate the climate impact of CEM into standard cost-effectiveness models. Because the social cost of carbon (SCC) varies across regions, providing raw physical data allows health economists to apply the SCC specific to their context. Finally, even though CEM emits more GHG than standard mammography, it provides a carbon-efficient alternative to MRI without compromising diagnostic performance.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE697
Topic
Economic Evaluation, Epidemiology & Public Health, Health Technology Assessment
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Novel & Social Elements of Value
Disease
Oncology