Environmental and Financial Cost Savings With Low-Consumption Intravitreal Injection Techniques

Purpose: To analyze the financial cost and environmental impact of supplies used during routine intravitreal injection of antivascular endothelial growth factor (anti-VEGF) therapies. Methods: The authors conducted a life cycle assessment of all supplies consumed during intravitreal injections of bevacizumab, aflibercept 2 mg, aflibercept 8 mg, and faricimab at a single academic institution. Data collected included weight, material composition, and retail price of the supplies. Two models, including a process-based approach and a hybrid life cycle assessment featuring an economic input-output model, were used to estimate the environmental impact. Three procedural protocols were analyzed, with an increasing supply consumption from protocol 1 to protocol 3. Results: Excluding the anti-VEGF medication, protocols 1, 2, and 3 cost $12.05, $40.79, and $88.69 and resulted in 3, 11, and 20 kg carbon dioxide equivalents, respectively, using the hybrid life cycle assessment. Extrapolating averaged findings from the hybrid life cycle assessment to the national volume of 15 million injections per year, this procedure may yield 5200 metric tons of waste, approaching $27 billion in material costs and more than 7.2 million metric tons of carbon dioxide equivalents annually. Excluding the anti-VEGF medication pack, this amounts to a procedural supply cost of more than $710 million and an environmental impact of 170 000 metric tons of carbon dioxide equivalents. Limiting supply consumption for all injections to protocol 1 may save more than 800 tons in waste, more than $500 million in cost, and 120 000 metric tons of carbon dioxide equivalents annually. Conclusion: Decreasing supply consumption during intravitreal injections with procedural variations, including the removal of speculums, calipers, or sterile gloves, may yield significant reductions in financial costs and environmental impact.