Effect of alternative dosing strategies on sustainable healthcare: A carbon footprint analysis of nivolumab and pembrolizumab treatment in the Netherlands.

Abstract

e13564 Background: Hospitals contribute significantly to greenhouse gas (GHG) emissions and face a moral obligation to prioritize reduction of GHG emissions. Drugs constitute an important component of the GHG emissions of hospitals. Alternative dosing strategies (ADS) have been implemented to improve the cost-effectiveness of pembrolizumab and nivolumab (Table). However, the impact of these ADS on GHG emissions remains unknown. Therefore, this study aimed to analyse the effect of ADS implementation on the carbon footprint of treatment with pembrolizumab and nivolumab. Methods: Life Cycle Assessment (LCA) methodology was used to quantify the environmental impact. The impact category climate change was used to quantify the carbon emissions (CO2e). The GHG Protocol was used to categorize the emissions into scopes 1, 2 and 3. Life Cycle Inventory and Impact data from an academic hospital in Rotterdam were used in the LCA to calculate the CO2e for pembrolizumab and nivolumab, their different dosing intervals, and the impact of ADS. Results: In 2022, the carbon emissions related to nivolumab and pembrolizumab treatment were 445 tons CO2e, with an average of 94 kg CO2e per dosage. Pharmaceutical production was the main driver of treatment-related GHG emissions (93% of total emissions on average). Applying ADS, resulted in carbon emission reductions of 21.4-26.2% and 9.3-11.2% for pembrolizumab and nivolumab respectively (table 1). Conclusions: This study shows the substantial environmental impact of cancer treatments with pembrolizumab and nivolumab and calls for further implementation of ADS for pembrolizumab and nivolumab and other anti-PD-(L)1 monoclonal antibodies and more sustainable pharmaceutical production processes. These findings help to create environmental awareness and contribute to the promotion and understanding of sustainable low-carbon healthcare practices. Overview of registered doses of pembrolizumab and nivolumab, alternative dosing strategies and potential reductions in GHG emissions, based on real world data in The Erasmus University Medical Center in Rotterdam, the Netherlands. [Table: see text]