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Objective: Inhalation therapy is the cornerstone of COPD, together with non-pharmacological treatments. Long-acting muscarinic antagonists (LAMAs), alone or in combination with long-acting beta-agonists (LABAs), are commonly used. Pressurised metered-dose inhalers (pMDIs), dry powder inhalers (DPIs) and soft-mist inhalers (SMIs) are used, each with different carbon footprints. This study aimed to assess the carbon footprint of hypothetically replacing LAMA or LAMA/LABA inhalers with an SMI, Respimat Reusable, within the same therapeutic class. Methods: An environmental impact model was established to assess the change in carbon footprint of replacing pMDIs/DPIs with Respimat Reusable within the same therapeutic class (LAMA or LAMA/LABA) across 12 European countries and the USA over 5 years. Inhaler use for country and diseasespecific populations was derived from international prescribing data and the associated carbon footprint (CO2 equivalents (CO(2)e)) was identified from published sources. Results: Over 5 years and across all countries, replacing LAMA inhalers with Spiriva Respimat Reusable reduced CO(2)e emissions by 13.3-50.9%, saving 93-6228 tonnes of CO(2)e in the different countries studied. Replacing LAMA/LABA inhalers with Spiolto Respimat Reusable reduced CO(2)e emissions by 9.5-92.6%, saving 31-50 843 tonnes of CO(2)e. In scenario analyses, which included total replacement of DPIs/pMDIs, consistent CO(2)e savings were estimated. Sensitivity analyses showed that results were sensitive to changes in several parameters including varying assumptions around reusability of inhalers and potential CO(2)e impact. Conclusion: Replacement of pMDIs and DPIs with Respimat Reusable within the same therapeutic class would result in substantial reductions in CO(2)e emissions.

How is a cost-effectiveness analysis constructed and used? In this episode of the Value Insider podcast, host Mike Chambers speaks with Prof. Maureen Rutten-van Molken about economic evaluations in healthcare and how value is considered in these evaluations. Prof. Rutten-van Molken is professor of Economic Evaluation of Innovations for Health at the Erasmus University Rotterdam in the Netherlands. She leads the Erasmus HTA department and is Scientific Director of the Institute for Medical Technology Assessment (iMTA). Prof Rutten-van Molken explains how comparative assessments can help us understand which treatments offer the best value-for-money as reimbursement can only be allocated to a selection of all possible treatments.