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P175 The true cost of switching to low global-warming potential inhalers. An analysis of NHS prescription data in england
  1. R Braggins1,
  2. J Smith2,
  3. AJK Wilkinson3
  1. 1University of Cambridge, Cambridge, UK
  2. 2Department of Public Health, University of Cambridge, Cambridge, UK
  3. 3East and North Hertfordshire NHS Trust, Stevenage, UK


Introduction and objectives The hydrofluorocarbons that replaced CFCs in MDIs have global warming potentials (GWPs) thousands of times greater than CO2, so MDIs are a major contributor to NHS greenhouse gas emissions.1 Dry powder inhalers (DPIs) are a low GWP alternative to MDIs recommended by BTS and UK government.1 2 Other European countries use DPIs far more than the UK, however the financial cost of DPIs is considered a barrier to their use in the UK.1 We investigated the financial implications for the NHS of switching from MDIs to DPIs.

Methods We analysed Net Ingredient Cost (NIC) data for England 2017 to calculate the ‘NIC per day of typical use’ for each inhaler and the total annual NIC in several scenarios where MDIs were replaced with clinically equivalent DPIs.

Results and conclusions More than £8.24 million and 68.6 kilotonnes of CO2 equivalent could be saved for every 10% of MDIs that are replaced with the cheapest clinically equivalent DPI. The cost of switching ICS, SABA and ICS/LABA/LAMA MDIs for the cheapest equivalent DPIs is overwhelmed by savings from switching LABA and ICS/LABA MDIs for the cheapest equivalent DPIs. Additionally greater uptake and greater efficiency of DPIs could further reduce their cost in the longer term. If at least 58% of the MDIs that are replaced are switched for the cheapest clinically equivalent DPI then the transition from MDIs to DPIs would be cost neutral, assuming that the remaining MDIs are replaced with DPIs in the same proportions that DPIs were prescribed in 2017.

Given the potential for both financial and environmental savings, the recommendations of the Environmental Audit Committee2 and the BTS Position Statement on The Environment and Lung Health,1 we anticipate a change in NHS policy. Every effort must be made to minimise greenhouse gas release to protect current and future generations from the worst effects of climate change. Patients, clinicians and policy makers should act now facilitate this change.


  1. Environment and Lung Health Position Statement 2017 British Thoracic Society.

  2. UK Progress on reducing F-gas Emissions Environmental Audit Committee – House of Commons, 25 April 2018.

Abstract P175 Figure 1

Change in Net Ingredient Cost and Global Warming Potential in ‘proportional’ and ‘cheapest’ MDI replacement with DPIs

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