Economic and Environmental Value of Low-GWP propellant pMDIs – A Multi-Country Impact Analysis

Pressurised metered dose inhalers (pMDIs) are widely used for asthma treatment, but contribute substantially to greenhouse gas emissions as they rely on hydrofluorocarbon propellants. As health systems adopt net zero targets, low-global warming potential (GWP) propellant pMDI have emerged as a potential alternative. This study evaluates the environmental and economic impact of transitioning to these alternatives across six European countries (France, Germany, Italy, the Netherlands, Spain, and the United Kingdom). The analysis used an “integrated evaluation” framework to quantify reductions in carbon dioxide equivalent (CO 2 e) emissions and converted them into (1) monetary units using country-specific carbon prices and (2) disability-adjusted life years using published health damage factors. Therapeutic equivalence was assumed between existing and low-GWP propellant pMDIs. Analyses were conducted at per patient and national levels, with sensitivity analyses for dosing and time horizons. Transitioning to low-GWP propellant pMDIs could reduce annual per-patient emissions by approximately 88%, equating to 90–132 kg CO 2 e saved per year. Monetised savings ranged from €18–€117 per patient annually and up to €2906 over a lifetime, depending on country and inhaler type. At a population level, an indicative cross-indication analysis indicates that full transition could save up to 33–415 million kg CO 2 e annually across the six countries. Transitioning to low-GWP propellant pMDIs can deliver substantial environmental and economic benefits. Integrating environmental impacts into health economic evaluation, particularly where clinical effects are equivalent, may support health systems in achieving net zero targets.