Effectiveness of different approaches to reduce scope 3 emissions from pharmaceuticals and medical equipment: a systematic review

Abstract Background: The healthcare sector is responsible for approximately 5% of global greenhouse gas (GHG) emissions and a large fraction of these are scope 3 emissions associated with the procurement, supply and disposal of medical equipment and pharmaceuticals. Objectives: To assess the effectiveness of interventions implemented by healthcare providers to reduce scope 3 GHG emissions associated with procurement, supply and disposal of pharmaceuticals and medical equipment. Methods: MEDLINE, Embase, CINAHL, the Cochrane Library and other topic-specific databases were searched from inception to February 2026. Studies were included if they assessed any intervention implemented by healthcare providers specifically intended to reduce scope 3 emissions from pharmaceuticals and medical equipment. The primary outcomes were GHG emissions and other environmental outcomes. Risk of bias was assessed using the RoB 2 tool for randomized controlled trials and the ROBINS-I tool for observational studies. A synthesis without meta-analysis was conducted due to wide variety of interventions and outcome measures across the studies. Results: We included 91 studies, mostly conducted in high-income countries. These studies evaluated 125 interventions, that focused on one or more strategies, most of which were implemented in the operating room. Overall, most interventions were associated with a reduction in scope 3 GHG emissions as well as economic savings, with little to no effects on clinical outcomes or patients’ safety, nor on operational outcomes (e.g. workload, staffing). However, most results are at serious risk of bias, and publication bias (i.e. lack of published negative/null results) is also likely. Discussion: Sustainable procurement and improved waste management, such as the use of reusable equipment and increased recycling, are effective in lowering the carbon footprint and costs across various healthcare settings. Our findings provide policy guidance on future actions healthcare providers can take to reduce GHG emissions. Funding: This work was funded by the National Institute for Health and Care Research (NIHR177921). The views expressed are those of the authors and not necessarily those of the NIHR. Registration: https://zenodo.org/records/18460450