AB023. Carbon and economic savings from reducing low-value care: case of appendicitis in Thailand

Background: Health sector is responsible for around 5–10% of the global greenhouse gas (GHG) emissions. World Health Organization (WHO) estimates 20–40% of current medical care is low value. Reducing such care can result in health, economic, and environmental co-benefits. The objective of this study is to estimate carbon and economic savings from reducing low-value appendicitis treatment in Thailand.

Methods: Data on potentially low-value appendicitis treatments in Thailand were extracted from our previous study across three periods: pre-pandemic (March–June 2019), lockdown (March–June 2020), and post-lockdown (March–June 2021). Carbon emissions related to appendicitis treatment were extracted from published literature: computed tomography (CT) scans [9.2 kg carbon dioxide equivalent (CO₂e)], ultrasound (0.5 kg CO₂e), open surgery (22.7 kg CO₂e), and laparoscopic surgery (27.4 kg CO₂e). Economic impact was estimated using the social cost of carbon at $0.185 per kg CO₂e.

Results: Appendicitis cases dropped by 13.4% and 16.4% during lockdown and post-lockdown, respectively. As a result, carbon emissions decreased by 11.6% during lockdown and 13.9% by 2021. However, CT scan use increased by 71.8% by 2021, creating 18.4 times more emissions than ultrasound. While treatment costs per case increased by 14.2% in 2021, total healthcare costs fell by 4.5% due to reduced appendicitis cases. Economic savings from averted social cost of carbon were estimated to be 458,921 Thai baht (THB) (~$13,000) from 2019 to 2021.

Conclusions: Reducing low-value appendicitis care can save money and reduce carbon emissions. Effective use of the updated World Society of Emergency Surgery (WSES) Jerusalem guidelines can help optimize diagnosis and treatment of appendicitis.

Keywords: Low-value care; appendicitis; carbon footprint; healthcare sustainability; social cost of carbon