Carbon footprint of maintenance and reliever therapy (MART) versus maintenance plus SABA (Mx+SABA) regimens for asthma: Results from the healthCARe-Based envirONmental cost of treatment (CARBON) programme

Abstract

<b>Background:</b> Globally, SABA represents most inhaler use and associated greenhouse gas (GHG) emissions. GINA recommends ICS/formoterol as the preferred reliever for patients with asthma. To date, the environmental impact of ICS/formoterol MART and maintenance (Mx)+SABA regimens has not been quantified. <b>Aim:</b> To model GHG emissions of MART vs Mx+SABA regimens. <b>Methods:</b> Total number of GINA step 3−5 patients prescribed ICS/LABA+/−SABA therapy in the UK was based on the SABa use IN Asthma (SABINA) I real-world study (Bloom C.I., et al. Adv Ther 2020;37:4190−4208). Market share data were used to estimate the number of ICS/LABA and SABA inhalers prescribed/year. The CO₂ equivalent (CO₂e)/device/year was derived from Janson et al (Thorax 2020;75:82−84). Exacerbation rates managed by primary and secondary care were estimated from SABINA and the CO₂e impact of resource use aggregated. <b>Results:</b> Total CO₂e/year for managing GINA 3−5 patients with inhaled therapies was 585,527 tonnes, 97% of which was driven by Mx+SABA use. DPI MART had the lowest carbon footprint (7 kg/patient/year assuming 6 inhalers/year) compared with pMDI MART (116 kg/patient/year) and Mx+SABA regimens (DPI: 119 kg/patient/year; pMDI: 242 kg/patient/year) (Figure). <b>Conclusion:</b> DPI MART has lower GHG emissions vs pMDI MART and Mx+SABA.