Incorporating the Environmental Impact into a Budget Impact Analysis: The Example of Adopting RESPIMAT® Re-usable Inhaler

Abstract

Background RESPIMAT ® re-usable enables patients to re-use the inhaler and its availability therefore reduces the number of inhalers and associated wastage. Objective The objective of this study was to perform an economic evaluation that incorporates the ecological impact of adopting RESPIMAT re-usable into the healthcare system in Germany. Methods Inhaler costs and environmental impact over 5 years in Germany in a scenario with RESPIMAT re-usable compared to a scenario without RESPIMAT re-usable were estimated using a budget impact model. The carbon emissions were derived for each treatment pattern considering the whole life cycle (cradle-to-grave) of the inhaler product. The cost of carbon emissions was estimated using a societal cost per ton of carbon emission. Results By introducing RESPIMAT re-usable in Germany, it was estimated that by 2023, the number of inhalers used would have decreased by 5,748,750 compared to a scenario without RESPIMAT re-usable. In addition, this measure would reduce the environmental burden of inhaler use while at the same time reducing medical cost of inhalers. Conclusions Adopting RESPIMAT ® re-usable to the national healthcare services may be a cost-saving option, which has the additional benefit of reducing the societal cost of carbon emissions. JEL Classification Q51 • Q58 Key Points for Decision Makers The healthcare sector is a major contributor to emissions of global greenhouse gases A broader approach to include the environmental effect when evaluating new health technologies may better capture the true value of a new product RESPIMAT re-usable reduces the societal cost of carbon emissions * Gustaf Ortsäter

The impact of switching from single-use to reusable healthcare products: a transparency checklist and systematic review of life-cycle assessments

“…With a budget impact model, Ortsäter et al . 27 , 28 assessed the environmental impact of adopting reusable inhalers; however, neither were classical LCA studies. Both reported reductions in GHG emissions of 50% and 63%, respectively, when switching from single-use RESPIMAT inhalers to reusable ones.…”

Incorporating environmental and sustainability considerations into health technology assessment and clinical and public health guidelines: a scoping review

“…Rather, it may be reserved for technologies expected to have a substantially negative environmental impact. However, a low relative reduction in environmental impact may translate into a large absolute impact if a technology is widely used, as is in the case of inhalers (25). On the other hand, studies emphasized the current lack of clarity over how committees and agencies might handle the trade-off between environmental and health effects, particularly when considering detrimental environmental consequences (largely a societal outcome) when a technology would otherwise be highly cost-effective (mainly an individual outcome) (24–26;28).…”

Repurposing mucosal delivery devices for live attenuated tuberculosis vaccines

“…This raises the possibility of using these pulmonary inhalers to deliver live mycobacteria vaccines. Currently, a broad range of liquid, mist, and powder-based inhalers are available and frequently prescribed ( 73 ). Based on the vaccine (liquid or powder) formulation, some of those available inhalers could be validated as a delivery device for inhaled live attenuated TB vaccines.…”