INTRODUCTION
Single use medical devices’ environmental impact is known to generate sizable carbon emissions over a life cycle compared to a reusable equivalent. The SHTG have recognised the need to evaluate this health technology carbon hotspot as part of the HTA. Specifically, this environmental assessment was appropriate for parallel evaluation alongside a health economic analysis to support the decision-making process.
METHODS
Through the application of HTA and environmental management principles and reporting, the Greenhouse Gas (GHG) Protocols, ISO14040 and Publicly Available Specification 2050, a carbon footprint of single use rhinolaryngoscopes was compared with a reusable equivalent. Process activity data, real world data and secondary data were used to quantify carbon intensity. Data were extrapolated to estimate national GHG emissions and waste volumes. The technologies were categorized using thresholds based on the functional unit, to strengthen support for the HTA decision making process. Sensitivity analyses were performed. Further recommendations were made to promote the use of more sustainable health technologies.
RESULTS
The carbon emissions of a single use flexible rhinolaryngoscope compared to its reusable equivalent was 6.03kgCO2e and 3.26kgCO2e respectively. Data extrapolation (2264 procedures per annum) reveals the annual environmental impact of this technology, throughout NHS Scotland, to be 13,652kgCO2e and 7,381kgCO2e, for the single use and reusable devices, respectively. Raw material acquisition, the use of personal protective equipment and transportation were health technology carbon hotspots. The estimated waste volumes are 12.58 tonnes and negligible volumes of clinical waste per annum for the single use versus reusable equivalent, respectively. This pilot study recommends the use a reusable equivalent in this setting.
CONCLUSIONS
Aligned with NHS net zero targets, these findings confirm the need to perform a parallel environmental assessment of technologies alongside a HTA. LCA is a useful framework to comprehensively assess environmental impact of health technology. Data constraints can be overcome through the use of hybrid methodologies, aligned with HTA principles including transparency and reproducibility to enable sustainable HTA decision making.