BACKGROUND: Single use health technologies are known to be approximately 50% more environmentally harmful than their reusable equivalent [1-3]. This novel pilot study was undertaken for the Scottish Health Technologies Group (SHTG) and is the first UK published parallel assessment alongside a cost effectiveness evaluation [4]. The aim of this research was to use hybrid and innovative methodological approach to evaluate environmental impact, utilising established multidisciplinary methods, in conjunction with HTA principles.
METHODS: Through the application of environmental management principles and reporting, the Greenhouse Gas (GHG) Protocols [5], ISO14040 [6] and Publicly Available Specification (PAS) 2050 [7] were applied in combination with overarching HTA principles. An environmental life cycle assessment (LCA) of single use rhinolaryngoscopes was compared with a reusable equivalent. A hybrid approach was used to collect data to quantify carbon intensity including, process activity data, real world data and secondary data. Data were extrapolated to estimate national GHG emissions and waste volumes to support NHS sustainability targets. The carbon output per functional unit were categorised using thresholds based on PAS recommendations to strengthen support for the HTA decision making process. Sensitivity analyses were performed to overcome data issues. Further recommendations were made support NHS net zero targets, promoting the use of more sustainable health technologies along the healthcare pathway.
RESULTS: The carbon emissions of a single use flexible rhinolaryngoscope compared to its reusable equivalent was 6.03kgCO2e and 3.26kgCO2e respectively. The findings of the report are in line with research reporting similar carbon emissions and provide important methods for HTA. 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 highlighted as carbon hotspots along the healthcare pathway. The estimated waste volumes are 12.58 tonnes and negligible volumes of clinical waste per annum for the single use versus reusable equivalent, respectively.
LIMITATIONS: A comparable LCA relies on a solid foundation of data. However, a high-level life cycle inventory based on good quality data was not possible for this parallel assessment, mainly attributed to the lack of access to primary data sources; influenced by a lack of regulation. Consequently, there was heavy reliance on secondary data and therefore the findings of this study may lack robustness and should be considered with caution.
IMPLICATIONS: The findings of this study support health technology environmental sustainability policy and framework development. This study recommends a hybrid methodological approach to evaluate environmental impact of health technologies. This approach supports product LCA [8] and carbon hotspot evaluation. This research also supports valuable data generation in a field nascent of research to support methodological development [9-11]. According to literature, this is the first parallel assessment as part of a HTA to be published [10]. Environmental outcomes used in the pilot study, align with government and NHS England net zero and waste reduction objectives [12]. This pilot study focuses on reporting GHG emissions. This is reasonable given that climate change and planetary health is determined largely by anthropogenic GHG emissions; fundamental for the stability of other environmental systems [13], and that national targets are focused on GHG emissions [12]. However, measuring GHG emissions and waste volumes only, can be considered a disadvantage, in that other important environmental impacts across other areas may be overlooked [1, 2, 14]. Therefore, future research should undertake a broader environmental assessment.