Effect of alternative dosing strategies of pembrolizumab and nivolumab on health-care emissions in the Netherlands: a carbon footprint analysis

Abstract

BACKGROUND: Hospitals contribute substantially to greenhouse gas emissions and face a moral obligation to prioritise emission reduction. Drugs constitute an important component of the greenhouse gas emissions of hospitals. Alternative dosing strategies (ADS) have been implemented to improve the cost-effectiveness of pembrolizumab and nivolumab. However, the impact of these ADS on greenhouse gas emissions remains unknown. Therefore, we aimed to analyse the effect of ADS implementation on the carbon emissions of treatment with pembrolizumab and nivolumab. METHODS: e. The functional unit of the study was the administration of a single dose of pembrolizumab or nivolumab. FINDINGS: e reductions for pembrolizumab and nivolumab, respectively. INTERPRETATION: This study shows the environmental impact of pembrolizumab and nivolumab treatment and calls for further implementation of ADS for pembrolizumab, nivolumab, and other anti-PD-(L)1 monoclonal antibodies, and more sustainable pharmaceutical production processes. Our findings create environmental awareness and contribute to the promotion and understanding of health-care practices with lower carbon emissions. FUNDING: None.