Environmental Impact Assessment of Intravenous Versus Subcutaneous Monoclonal Antibodies: A Carbon Footprint Analysis

PURPOSE: 

The development of subcutaneous (SC) formulations for monoclonal antibodies (mAbs), as an alternative to conventional intravenous (IV) infusion, represents a shift in health care delivery. The relative environmental impact of these two administration methods is not well understood. Minimizing the environmental footprint of health care is crucial due to its substantial contribution to greenhouse gas (GHG) emissions. This study compared the carbon footprint of SC and IV administration using pertuzumab/trastuzumab as a case example.

METHODS: 

A Life Cycle Assessment was conducted to compare the environmental impacts of IV versus SC administration of pertuzumab/trastuzumab, focusing on climate change impacts expressed in carbon dioxide-equivalents (CO2e). The analysis included emissions from single-use medical equipment, drug manufacturing, hospital operations, patient and staff transportation, and waste disposal.

RESULTS: 

SC pertuzumab/trastuzumab resulted in slightly higher GHG emissions than IV administration, with 47.2 kg CO2e for loading doses compared with 45.9 kg CO2e, and 33.6 kg CO2e for maintenance doses compared with 32.9 kg CO2e. This increase was primarily due to the higher dosage required for SC delivery, with mAb production contributing the most to emissions. Nonetheless, SC administration reduced the use of single-use medical equipment and treatment-related energy consumption in health care facilities. Switching to SC pertuzumab/trastuzumab administration in the Netherlands in 2022 would have increased annual CO2e emissions by 12.2 tons, equivalent to driving 63,212 km in a petrol-powered car.

CONCLUSION: 

Both IV and SC administration routes of mAbs have substantial environmental impacts, dominated by mAb production emissions. This research provides a framework for assessing the environmental impact of health care technologies and underscores the importance of integrating environmental considerations into health technology assessments to mitigate the significant contribution of health care to global GHG emissions.