Environmental parallel assessment alongside a health economic analysis

Dear Colleagues,

Pleased to share with you the first environmental "parallel assessment" (Toolan et al., 2022) alongside a health economic analysis that I undertook last year for the Scottish Health Technologies Group titled; An assessment of local anaesthetic biopsies of suspicious laryngeal and pharyngeal lesions. See resource link below please.

Here are the key findings which support financial and environmental sustainability of using reusable flexible rhinolaryngoscopes for this application, in an outpatient setting in NHS Scotland:

Biopsies under local anaesthetic can be undertaken in an outpatient setting, as an alternative to inpatient or day case biopsy procedures which require theatre time and a hospital bed.
Biopsies under local anaesthetic are effective in identifying people who do not require further follow up. This means that patients can have their biopsy taken under local anaesthetic at the time of initial outpatient investigation and avoid needing a confirmatory biopsy under general anaesthetic in an operating theatre.
Undertaking biopsies in an outpatient setting provides an opportunity to ease hospital resource pressures and reduce waiting times to diagnosis and treatment. A reduction in the number of patients requiring inpatient biopsy procedures will lead to substantial resource savings for NHS Scotland.
In circumstances where the use of reusable biopsy equipment is not feasible (for example, during the COVID-19 pandemic) disposable biopsy equipment provides an alternative means to perform biopsies. It should be noted that:
no evidence is currently available to determine whether disposable biopsy equipment is as effective as reusable biopsy equipment
the use of disposable biopsy equipment is more costly than the use of reusable equipment
over the lifecycle, reusable equipment produces fewer carbon emissions compared with disposable equipment
Exploratory environmental analysis: 

◼ The estimated annual carbon impact of using disposable rhino laryngoscopes for biopsy procedures is higher compared with reusable rhino laryngoscopes (13,652 kgCO2e versus 7,381 kgCO2e )

◼ Over a life cycle assessment (LCA), a reusable flexible rhino laryngoscope emits 48% less carbon emissions compared with disposable rhinolaryngoscopes

◼ Use of disposable devices in all biopsy procedures involving patients in Scotland who have suspected laryngeal and pharyngeal cancers produces 12.6 tonnes of clinical waste per year compared to a negligible volume of waste for reusable devices

Please note:

I tried to get hold of granular primary activity data for a LCA. However, this was not possible. Therefore the analysis is restricted in its conclusions. Nonetheless, I applied a wide range of methods to get the most of the data I used and my findings were in line with other research. To acquire as much data as possible, I interviewed NHS staff including (not an exhaustive list) sterile services managers, endoscopy managers, a sustainability manager, a waste manager, healthcare suppliers and provided an industry questionnaire to try to obtain LCA data. I also performed sensitivity analysis to altered the life span of the reusable device and use of the automated endoscopic reprocessor, for example, as well applying a number of parameter changes to the model analysis to check the difference in outcome to support a fair comparison.  Also note, my use of the term environmental impact assessment (EIA) is not the correct term for this type of analysis.

Kind regards

Mel