OBJECTIVES: The current gold-standard for estimating value in health-technology assessments is the incremental-cost-effectiveness ratio. However, alternative methods of assessing value may be required in the future as societal priorities change. One example is a value-metric for new therapies based on their carbon footprint. This would be aligned with wider long-term public policy objectives and support carbon emission reduction targets. Here we provide a conceptual model to estimate the carbon footprint of chronic kidney disease (CKD).

METHODS: CKD is a potentially fatal progressive disease with high unmet need. Complex treatments (dialysis and transplantation) combined with high prevalence leads to an extensive and substantial carbon footprint. To estimate the benefits of comparing alternative treatment pathways, we propose the following conceptual linear model based on individual resource-use, associated emissions, and CKD epidemiology. The first step is to determine components in the treatment pathway, such as dialysis, transplantation, and pharmacotherapy, based on national and international guidelines. The next is to estimate the carbon footprint for each component, based on the activities involved within each component. The final step is to use epidemiology data to estimate number of people using each component per year in each country.

RESULTS: This model will be easily adaptable to different countries as epidemiology data can be used to adjust resource-use based on national clinical practice. This will enable comparisons across countries and provide relative measure to carbon emissions. Sensitivity analysis will highlight which parts of the treatment pathway are ‘carbon heavy’ and therefore enable health care providers with opportunities to target their reduction opportunities.

CONCLUSIONS: This novel modelling approach offers a progressive step towards future HTA and potential cost-benefit analyses, e.g., carbon emissions offset per person, that will provide broader environmentally targeted measures of value than are currently employed.