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Abstract
Introduction
Asthma exacerbations are a primary driver of costs and health impacts from asthma. Despite research suggesting that asthma care has a disproportionate carbon footprint, emissions costs are not considered when evaluating its societal burden. To advance the understanding of greenhouse gas (GHG) emissions associated with asthma, we estimated the carbon footprint and associated costs of asthma exacerbation care by severity level among UK adults.
Methods
Guidelines for asthma exacerbation treatment in UK adults were reviewed by severity level: mild, moderate, and severe/life-threatening. Components of care for each severity were evaluated for GHG emission potential and key drivers were identified. Carbon dioxide equivalent (CO2e) emissions of drivers were sourced from published literature and combined to estimate the carbon footprint per exacerbation, by severity level. Emissions were scaled up to the annual UK adult population based on the annual number of exacerbations at each severity. Costs associated with emissions were estimated using the UK government’s 2020 nontraded price of carbon, at ₤71 per tonne CO2e (tCO2e).
Results
Overall, emissions drivers for exacerbations were medical services, including patient-travel, and quick-relief inhalers. The annual number of mild, moderate, and severe/life-threatening asthma exacerbations among UK adults were 118.9 M, 5.5 M, and 2.4 M. Associated annual carbon footprints were estimated to be 83,455 tCO2e, 192,709 tCO2e, and 448,037 tCO2e for mild, moderate, and severe/life-threatening exacerbations, respectively, with a total of 724,201 tCO2e. Total annual emissions costs from exacerbation care were £51.3 M; ₤5.9 M, ₤13.6 M, and ₤31.7 M for mild, moderate, and severe/life-threatening exacerbations, respectively.
Conclusion
GHG emissions from asthma exacerbation management were the highest for severe/life-threatening events, followed by moderate exacerbations. Treatment to reduce the severity and occurrence of exacerbations, such as effective, long-term control therapy via lower-emission dry powder inhalers (DPIs), can help mitigate asthma care emissions. For mild exacerbations, the use of DPIs can eliminate associated emissions.
Transparency
Declaration of funding
This study was funded by Novartis Pharma AG, whose employees were involved in the study design, writing of the report, and the decision to submit the paper for publication.
Declaration of financial/other relationships
IF, JS, KKS, KN, and TS are employees of Analysis Group, Inc. a consultancy that received funding from Novartis Pharma AG to conduct this study. PT is the director of PT Health Economics Ltd, a consultancy that received funding from Novartis Pharma AG to consult on this study. JM and RI are employees of and own stocks in Novartis Pharma AG. JM has received medical writing services from Novartis Pharma AG. AC and HK are employees of Novartis Healthcare Private Limited.
A reviewer on this manuscript has disclosed that they have performed consulting, served on advisory boards, or received travel reimbursement from Amphastar, AstraZeneca, Chiesi, Connect Biopharma, GlaxoSmithKline, Mylan, Novartis, Sunovion, and Theravance. They have also conducted multicenter clinical research trials for some 40 pharmaceutical companies. The other peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.
Author contributions
All authors contributed to the study design and conception. IF, KKS, and KN conducted the analyses. IF, JS, KKS, KN, and TS drafted the initial manuscript. All authors revised the manuscript. All authors approved the final manuscript as submitted.
Acknowledgements
None reported.
Previous presentation
These data were previously presented at the ISPOR EUROPE 2021 Annual Congress.