Tallying financial, environmental costs of medical waste in cataract surgery

Up to 60% of drugs used during surgery were discarded, costing thousands of dollars each year, according to a study. Eye drops went unused more often than any other medication, due to standard procedures such as opening a new bottle for each patient.

Reviewed by Jenna Tauber, BS, and Cassandra L. Thiel, PhD

The healthcare sector is a large contributor to financial and environmental waste and climate change, and the operating room-generator of one-third of all healthcare facility waste-is a prime location to begin making changes, according to Jenna Tauber, BS, a 2019 MD/MS candidate at NYU Langone Eye Center, New York University School of Medicine, New York.

Tauber and a team of colleagues from the eye center studied the financial and environmental costs of pharmaceutical waste during routine phacoemulsification surgery at four surgical sites in two major urban areas.

Recurring issue

Previous work on the disposal of operating room supplies, conducted by senior author Cassandra L. Thiel, PhD, found that unused pharmaceuticals were a recurring issue, and the group decided to take a closer look and quantify the scope of the problem. Dr. Thiel is an assistant professor at the Robert F. Wagner NYU Graduate School of Public Service and has a joint appointment at NYU Langone School of Medicine in the Department of Population Health.

The study revealed that up to 60% of drugs used during surgery were discarded at a cost of thousands of dollars a year per site, resulting in significant environmental impacts, including the unnecessary release of carbon emissions.

Eye drops were unused more than any other medication, due to standard procedures such as opening a new bottle of medication for each patient while using only a few drops in each case.

“Policies vary by institution, but it’s time we think harder about the impact these policies have on the environment,” Tauber said. “Physicians have a say in the supplies purchased and supplied in their operating rooms, and they should feel empowered to address this issue.”

One tool for this type of analysis is life-cycle assessment (LCA), which can help assess the environmental footprint of medical systems by tracking emissions associated with each stage of a product’s life cycle-raw materials extraction, manufacturing, packaging and distribution, use, and disposal.

For this particular study, investigators used an online LCA tool from Carnegie Mellon University that estimates the impact of expenditures in specific industrial sectors, such as pharmaceutical preparation manufacturing, on a variety of environmental and health-related factors.

“In health research, we care about those outcomes that can directly impact human individual and global health,” said Tauber, adding that the group looked at carbon emissions, air pollution, and eutrophication potential.

Cataract surgery, the most commonly performed surgical procedure in the United States (about 3.6 million surgeries per year), was chosen as a “model organism” for analyzing financial and environmental impacts on the healthcare system.

Members of the team attended 10 or more routine cataract surgeries at each of the study sites:

• a private ambulatory-care center,
• a private tertiary-care center,
• a private outpatient center, and
• a federally run medical center for veterans.

They weighed the volume of medication remaining postoperatively and obtained institutional financial data to estimate the cost of the remaining medication, and then applied the LCA model to convert financial waste into environmental emissions.

Unique drugs measured

The team measured 116 unique drug formulations and found the average quantity of unused drugs by weight ranged, by center, from 16% to 60%. Extrapolating data on drug expenses per month and unused drug costs per case, they estimated that the unused drug cost per year exceeded $190,000 at two of the centers and more modest totals of $37,000 and $55,000 at the others.

In a further analysis, the drugs were categorized as eye drops, ocular injections, or systemic medications. At three of the four centers, eye drops were discarded significantly more often than other medications. At the fourth, waste from ocular injections slightly exceeded that from drops.

The findings also showed that negative environmental emissions were generated unnecessarily, Tauber said. In sum, the costs of pharmaceutical waste were enormous, she added.

“Across four surgical locations, a minimum of $36,900 was wasted per year,” Tauber said.

“At two sites, over $190,000 in drugs were thrown out in one year. And as cataract surgery costs an average of $3,600 per eye, this waste theoretically could have covered an additional 53 surgeries at each of the latter two locations.” The environmental costs were also high.

“Considering 2011 U.S. cataract surgery prevalence estimates, we can estimate contributing an unnecessary 23,000 to 105,000 metric tons of carbon emissions toward climate change,” Tauber said.

“The estimated environmental emissions associated with unused pharmaceuticals are theoretically equivalent to driving a car from Anchorage to Miami, up to 51,400 times every year.”

Seeking solutions

With data showing the scope of the waste problem, the subsequent question is how to reduce it. Waste from eye drops might be lessened by resizing to smaller containers, multi-dosing for some agents, or developing multiuse eye drops, Tauber suggested.

However, a change such as using the same bottle of medication for multiple patients or dispensing certain drugs (like antibiotics) to the patients for home use would require updating current regulations.

Disclosures:

Jenna Tauber, BS
P: 646/929-7870/E: jenna.tauber@nyulangone.org
This article was adapted from Tauber’s presentation at the 2018 meeting of the American Academy of Ophthalmology. She did not report any relevant disclosures.