Sustainability in medical retina: the environmental impact of using aflibercept 8 mg instead of aflibercept 2 mg in treatment-naïve patients with nAMD

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Abstract Background/Objectives Sustainability is a major concern with the use of intravitreal therapy for neovascular age-related macular degeneration (nAMD), as case numbers rise with the ageing population. The aim of this study is to quantify the difference in the carbon emissions from factory gate to patient between aflibercept 2 mg pre-filled syringe (PFS) and aflibercept 8 mg PFS when used over the first 2 years in treatment-naïve patients with nAMD in the UK. Methods The carbon footprint per injection was calculated by adding carbon emissions—obtained from internal corporate and published data—for packaging creation, transport, patient travel and waste disposal for each product. Results were extrapolated to a UK population using an estimate of the number of injections from real-world evidence and/or clinical trial data and the published incidence of nAMD. Results Between factory and patient, the carbon emissions for aflibercept 2 mg PFS are approximately 2.3 kg CO 2 per injection, compared with 2.1 kg CO 2 for aflibercept 8 mg PFS. Using aflibercept 8 mg PFS instead of aflibercept 2 mg PFS for treatment-naïve patients with nAMD in the UK would result in ~68,000–272,000 fewer hospital visits over the first 2 years and decrease emissions by ~277,000–736,000 kg CO 2 . Conclusions Using aflibercept 8 mg PFS instead of aflibercept 2 mg PFS in treatment-naïve patients with nAMD has benefits for the environment and National Health Service (NHS) capacity and would therefore help meet NHS sustainability goals.