Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England

Abstract

ObjectivesMetered-dose inhalers (MDIs) contain propellants which are potent greenhouse gases. Many agencies propose a switch to alternative, low global warming potential (GWP) inhalers, such as dry powder inhalers (DPIs). We aimed to analyse the impact on greenhouse gas emissions and drug costs of making this switch.SettingWe studied National Health Service prescription data from England in 2017 and collated carbon footprint data on inhalers commonly used in England.DesignInhalers were separated into different categories according to their mechanisms of action (eg, short-acting beta-agonist). Within each category we identified low and high GWP inhalers and calculated the cost and carbon impact of changing to low GWP inhalers. We modelled scenarios for swapping proportionally according to the current market share of each equivalent DPI (model 1) and switching to the lowest cost pharmaceutically equivalent DPI (model 2). We also reviewed available data on the carbon footprint of inhalers from scientific publications, independently certified reports and patents to provide more accurate carbon footprint information on different types of inhalers.ResultsIf MDIs using HFA propellant are replaced with the cheapest equivalent DPI, then for every 10% of MDIs changed to DPIs, drug costs decrease by £8.2M annually. However if the brands of DPIs stay the same as 2017 prescribing patterns, for every 10% of MDIs changed to DPIs, drug costs increase by £12.7M annually. Most potential savings are due to less expensive long-acting beta-agonist (LABA)/inhaled corticosteroids (ICS) inhalers. Some reliever inhalers (eg, Ventolin) have a carbon footprint over 25 kg CO2e per inhaler, while others use far less 1,1,1,2-tetrafluoroethane (HFA134a) (eg, Salamol) with a carbon footprint of <10 kg CO2e per inhaler. 1,1,1,2,3,3,3-Heptafluoropropane (HFA227ea) LABA/ICS inhalers (eg, Flutiform) have a carbon footprint over 36 kg CO2e, compared with an equivalent HFA134a combination inhaler (eg, Fostair) at <20 kg CO2e. For every 10% of MDIs changed to DPIs, 58 kt CO2e could be saved annually in England.ConclusionsSwitching to DPIs would result in large carbon savings and can be achieved alongside reduced drug costs by using less expensive brands. Substantial carbon savings can be made by using small volume HFA134a MDIs, in preference to large volume HFA134a MDIs, or those containing HFA227ea as a propellant.

Environmental impact of inhalers for respiratory diseases: decreasing the carbon footprint while preserving patient-tailored treatment

“…For MDI, values of gCO 2 e per dose (two actuations) range from 164 to 238. The calculated values are lower, or in the lower range, compared with what has been reported in recent publications 11 and much lower compared with the value reported in the NICE Patient decision aid. 9 Despite the very limited contribution of HFAs in pharmaceutical use to the total HFA emissions, a structured approach should be adopted to move to more sustainable solutions to treat respiratory diseases.…”

Climate change in healthcare: Exploring the potential role of inhaler prescribing

“…Overall, it was modeled that for every 10% of pMDIs that are replaced by cheapest DPI alternatives, more than £8.24 million could be saved annually. 17 Similarly, Korean and South Indian studies have failed to show a significant difference in overall costs between DPI and pMDI. [34][35][36] This renders the historical assumption of DPIs being more expensive than pMDIs as questionable and hence should not be seen as a barrier to DPI prescriptions.…”

Eit klimanøytralt helsevesen: på tide å ta grep!

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