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Original Investigation
August 1, 2019

Quantification of the Cost and Potential Environmental Effects of Unused Pharmaceutical Products in Cataract Surgery

Author Affiliations
  • 1NYU Langone Eye Center, New York University School of Medicine, New York
  • 2currently a student at Macaulay Honors College at Hunter College, City University of New York, New York
  • 3Department of Population Health, New York University School of Medicine, New York
JAMA Ophthalmol. Published online August 1, 2019. doi:10.1001/jamaophthalmol.2019.2901
Key Points

Question  What are the costs and potential environmental effects of unused pharmaceutical products from standard phacoemulsification surgery?

Findings  In a qualitative evaluation of 4 US surgical sites, the greatest proportion of unused pharmaceuticals during phacoemulsification consisted of eyedrops, with cost estimates of as much as $195 200. The potential monthly environmental effect would reach carbon dioxide equivalents of 2498 kg, fine particulate matter of 10 μm or less in diameter equivalents of 4.5 kg, and nitrogen equivalents of 0.42 kg.

Meaning  This study suggests that unused pharmaceutical products after phacoemulsification result in relatively high financial and environmental costs; if these results are substantiated and shown to be generalizable in the United States or elsewhere, reducing these costs may be of value.

Abstract

Importance  Pharmaceutical products, including unused portions, may contribute to financial and environmental costs in the United States. Because cataract surgery is performed millions of times each year in the United States and throughout the rest of the world, understanding these financial and environmental costs associated with cataract surgery is warranted.

Objective  To investigate the financial and environmental costs of unused pharmaceutical products after phacoemulsification surgery.

Design, Setting, and Participants  This descriptive qualitative study included 4 surgical sites in the northeastern United States (a private ambulatory care center, private tertiary care center, private outpatient center, and federally run medical center for veterans). Prices and data for use of services and pharmaceuticals were obtained for the tertiary care and outpatient centers from January 1 through April 30, 2016; for the ambulatory care center from June 1, 2017, through March 31, 2018; and the federal medical center from November 1, 2017, through February 28, 2018. Data were collected from routine phacoemulsification surgical procedures without vitreous loss or other complications. Volume or weight of medications remaining after surgery was measured. Total and mean costs of medications per case and month were calculated. Environmental effects were estimated using economic input-output life cycle assessment methods. Data were analyzed from December 1, 2017, through June 30, 2018.

Main Outcomes and Measures  Cost of unused pharmaceutical products (in US dollars) and kilogram equivalents of carbon emissions (carbon dioxide [CO2-e]), air pollution (fine particulate matter emissions of ≤10 μm in diameter [PM10-e]), and eutrophication potential (nitrogen [N-e]).

Results  A total of 116 unique drugs were surveyed among the 4 centers. Assuming unmeasured medications had no materials left unused, a cumulative mean 83 070 of 183 304 mL per month (45.3%) of pharmaceuticals were unused by weight or volume across all sites. Annual unused product cost estimates reached approximately $195 200 per site. A larger percentage of eyedrops (65.7% by volume) were unused compared with injections (24.8%) or systemic medications (59.9%). Monthly unused quantities at the ambulatory care center (65.9% by volume [54 971 of 83 440 mL]), tertiary care center (21.3% [17 143 of 80 344 mL]), federal medical center (38.5% [265 of 689 mL]), and outpatient center (56.8% [10 691 of 18 832 mL]) resulted in unnecessary potential emissions at each center of 2135, 2498, 418, and 711 kg CO2-e/mo, respectively. Unnecessary potential air pollution between sites varied from 0.8 to 4.5 kg PM10-e/mo, and unnecessary eutrophication potential between sites varied from 0.07 to 0.42 kg N-e/mo.

Conclusions and Relevance  This study suggests that unused pharmaceutical products during phacoemulsification result in relatively high financial and environmental costs. If these findings can be substantiated and shown to be generalizable in the United States or elsewhere, reducing these costs may be of value.

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