Impact of Local Intravitreal Injection Delivery on Cost, Carbon Emissions, and Attendance in Yellowknife, Northwest...

Purpose: To compare a remote retina clinic model to a referral-based model in terms of cost, compliance, and carbon impact for a fly-in, fly-out ophthalmology clinic in Yellowknife, Northwest Territories, Canada. Methods: Data were collected retrospectively from all living patients in the Northwest Territories who were referred for intravitreal injections from clinic inception in 2021 to November 2024. We estimated carbon emissions, costs, and appointment attendance for care delivered in Yellowknife vs care received via referral to Edmonton (Alberta Retina Consultants clinic). Results: A total of 171 patients were included. Carbon emission analysis (n = 171) showed a total mean difference of 12 6410 kg of carbon dioxide emissions used for patient travel between patients who received care locally (producing 77% lower emissions) vs those traveling to Edmonton. The estimated mean cost difference (n = 171) for patients receiving care in Yellowknife vs those traveling to Edmonton for care was more than CAD$1.6 million annually, with the majority attributed to transportation. Attendance analysis (n = 52) showed a higher rate of missed appointments in Edmonton vs Yellowknife (mean ± SD, 21.3 ± 14.4% vs 14.3 ± 15.6%, respectively). Conclusions: Delivering intravitreal injections locally in Yellowknife was associated with improved patient attendance to appointments, reduced costs, and reduced carbon emissions compared with retinal care provided via the traditional referral-based system in Edmonton.