OBJECTIVES: The UK NHS is committed to achieving net zero direct carbon emissions by 2040. Nitrous oxide (N₂O) is a greenhouse gas used for pain relief during contractions in labor. Destruction technology (DT) can help the NHS achieve its target by breaking N₂O down into nitrogen and oxygen. This study evaluated the impact of introducing N₂O DT in labou=r wards on NHS emissions and costs.

METHODS: A cost-consequence model was developed to estimate the per delivery incremental cost, and NHS cost impact, of implementing DT. A pragmatic literature search was conducted to identify all model inputs. N₂O emissions were monetized by converting into CO₂ equivalents (CO₂e) and using the 2022 marginal abatement CO₂e costs. Scenario analysis explored the impact with varying rates of N₂O use and one-way deterministic sensitivity analysis was used to identify the main drivers of results.

RESULTS: N₂O DT is estimated to be cost saving to the NHS when valuing emissions monetarily. Per-delivery savings vary from £14.09 to £135.20 for emergency caesarean section labors (which use less N₂O) and labors using N₂O for every contraction, respectively. The per-delivery cost of mobile DT units is £5.57, and £10.10 for central units. It would cost the NHS £22,512,210 and £40,765,953 to purchase and maintain mobile and central DT units, respectively, for all UK consultant-led labor wards. Sensitivity analysis shows the amount of N₂O used, the carbon value, and the effectiveness of DT impact results most, though DT remains cost saving in all scenarios.

CONCLUSIONS: he reduction in emissions offsets the cost increase of DT when these emissions are monetized. This raises the wider question of whether the environmental impact of technologies should be formally quantified in cost-effectiveness analyses because it may be a key driver of the conclusions. This study also adds to evidence from European studies to support DT implementation.