Much of the pharmaceutical sector is working to achieve carbon neutrality over next decade, across the entire value chain, driving an increasing need for suppliers to provide more sustainable solutions for the pharmaceutical products delivered to the patient end user. This includes not only suppliers of raw materials intended for pharmaceutical products, but also drug delivery device and packaging suppliers. Single use drug delivery devices are of particularly significant, as they represent one of the largest sources of waste in the pharmaceutical supply chain.[i] Some device companies, in an effort to achieve carbon neutrality targets set by pharmaceutical partners, will compensate for carbon emissions through carbon offsets through building improvements, investing in renewable energy, tree planting, or even just the purchase of carbon offsets through designated markets. However, this approach does not directly address the core issue of waste in single-use systems and is often referred to as “green washing”.
While the need for sustainability improvements exists for all drug delivery formats, it is particularly critical for injectable drugs given the likelihood of increased waste from the associated device. Behind oral medication, injectables represent the largest product delivery method in the pharmaceutical industry. Just in the home setting, over 7.8 billion hypodermic needles are used each year by the nearly 13.5 Million people who self-inject medication outside a Healthcare setting. This combined figure represents a mixture of both manual hypodermic needles and autoinjectors. Although autoinjectors provide additional usability and safety benefits over bare syringes and prefilled syringes, they are likely to significantly increase the amount of waste associated with each injection. So, in meeting sustainability targets, they need particular consideration.
We developed the Aria smart autoinjector, a semi-reusable system with a reusable drive unit and disposable cassette. In reducing the amount of material disposed with each injection, we assumed this would lead to measurable sustainability improvements compared to fully disposable autoinjectors. However, it was critical to validate these assumptions. Leveraging Life Cycle Analysis (LCA),[ii] we evaluated all environmental impacts across the Aria life cycle, from raw material extraction through use and to disposal.
In a recent issue of ONdrugDelivery, we published select findings of this study.[iii] Reduced packaging and refrigeration needs result in a 10-fold reduction in energy consumption for the Aria smart autoinjector, compared to representative, commercially available, disposable autoinjectors. Further, we determined that the Aria device format led to a 50% and 70% reduction in CO2 for 1.0 mL and 2.5 mL device volumes, respectively.
Evaluating the overall environmental impact, per injection, for both the Aria smart autoinjector and commercially available (disposable) autoinjectors, across the entire device lifetime, it is possible to see the true impact of sustainability improvements with the Aria device format (c.f. Figure 1). Assuming monthly injections, Aria achieves the same sustainability as a comparable disposable autoinjector. This is notable, because the Aria autoinjector reusable drive unit contains electronics that the commercially disposable mechanical autoinjectors lack, but this is largely offset by the ability to reuse.
However, a twice monthly or weekly injection cycle is a more common scenario for drugs. With twice monthly or weekly injections, the lifetime sustainability improvements are clear.
Connectivity adds a further complication in assessing the sustainability impact of a device. On one hand the electronics required for connectivity increases environmental impact of a device but against that, connectivity can potentially reduce impact if, for example, it improves medication adherence, reducing the risk of hospitalization or the need for additional healthcare consultants. This is an area that still needs further exploration, taking into account the care pathway for a specific treatment and the consequences of poor medication adherence but there is some data to show there are sustainability benefits[iv]. But for now, given increased interest in connectivity, it is worth considering the impact of different technical approaches to connectivity and how they impact device sustainability. There are 3 main approaches to include connectivity into drug delivery devices
- integrate the electronics into a disposable device so it is only used once but provides the users with a very similar user experience to the original device
- provide an add-on unit that can be transferred from one disposable device to another reducing the environmental of each delivery event but increasing patient burden through the need to transfer the unit between devices.
- use a reusable electronic device such as the Aria autoinjector where connectivity is integrated into the devices and used for multiple injections
With this in mind, we used LCA to evaluate the carbon emissions for Aria+, the advanced version of Aria that includes a graphical display and thus presents a worse case for environmental impact for the device and compared that to emissions data from the LCA for comparable, disposable, autoinjectors. Using Aria+ smart autoinjectors to treat a cohort of 100,000 patients for a year yielded a 3-fold reduction in carbon emissions compared to a disposable autoinjector with an add-on connectivity module; and a 5-fold reduction in carbon emissions compared to a disposable autoinjector with integrated electronics for connectivity (c.f. Figure 2).
The reduction in carbon emissions between using Aria and a disposable autoinjector corresponds to the electricity use in 2917 homes for one year, over 1.86 million liters of gasoline, and the amount of carbon sequestered by over 72,000 tree seedlings grown for 10 years. The demonstrates that a change in device strategy to the use of reusable devices provides meaningful and significant impact toward improved sustainability.
Improved sustainability not only assists in meeting business and governmental objectives toward carbon neutrality but also addresses a desire by many patients to provide solutions with superior environmental friendliness, while still maintaining high standards of safety and efficacy. But despite this, it is clear from patient feedback that we have received, that more sustainable devices cannot come to the detriment of good usability and convenience. In the forthcoming weeks, we will show in future blogs how, Aria and Aria+ meet patient needs around ease of use, reassurance and safety in self-medication, while improving sustainability.
[i] Patel and Sheridan. “Sustainability in Drug Delivery: A Green Future Without Compromising Safety and Efficacy”, https://www.paconsulting.com/newsroom/expert-opinion/chemistry-today-sustainability-in-drug-delivery-a-green-future-without-compromising-safety-and-efficacy-7-april-2021/, accessed October 28, 2021.
[ii] Reference Blog 1.
[iii] Reference ODD article.
[iv] Digital Adherence Monitoring in Poorly Controlled Paediatric Asthma, Sustainability Healthcare Coalition, https://shcoalition.org/wp-content/uploads/2019/12/Digital-Adherence-Monitoring-in-Poorly-Controlled-Paediatric-Asthma-Final.pdf. Retrieved August 12 2021