P0027 The carbon footprint of remote monitoring of IBD patients – a green opportunity for sustainable outpatient care
Authors: Hendrix E M B , de Jong D C , de Jong M J , Becx M C J M , van Bodegraven A A , Dijkstra G , Kimman M , Mahmmod N , Maljaars J P , van der Meulen-de Jong A E , Mujagic Z , Romberg-Camps M J , Pierik M J , Duijvestein M 
Published: January 2025

Abstract

Background
Climate change is a major public health threat, with healthcare systems contributing 4-5% of global greenhouse gas (GHG) emissions. Inflammatory Bowel Disease (IBD), a chronic and increasingly prevalent condition, demands extensive healthcare resources, making healthcare for this patient population a notable contributor to carbon dioxide (CO2) and other GHG emissions. Remote care offers an opportunity by reducing transport-related emissions through fewer outpatient visits. In this study we aimed to assess the carbon footprint of IBD care and compare the emissions associated with remote versus standard care.

Methods
A randomized controlled trial involving 909 IBD patients from two academic and two non-academic hospitals in the Netherlands compared telemedicine via myIBDcoach with standard outpatient care for a 12-month period.1 In an explorative analysis, the annual carbon footprint of IBD-related healthcare, expressed as CO2-equivalent (CO2e), was estimated, covering outpatient and inpatient services, diagnostic procedures (i.e., endoscopy, radiology), surgeries, and patient travel (assuming 100% car use).2 Staff travel, laboratory tests, and medication use were out of scope. Emission conversion factors were derived primarily from Dutch literature and supplemented with international sources (Table 1).

Results
The total annual carbon footprint for all patients was 53,779 kg CO2e (Figure 1), mainly driven by hospitalization (50.6%) and patient travel (29.0%, mean travel distance: 20.3 km). Per IBD patient, the mean annual carbon footprint was 65.5 kg CO2e in the standard care group (n=443) and 56.5 kg CO2e in the remote monitoring group (n=438), saving 9.0 kg CO2e per patient annually. Reduced outpatient visits in the remote monitoring group accounted for most savings, with annual emissions dropping from 21.6 kg CO2e to 14.3 kg CO2e, saving 7.3 kg CO2e per year. Scaling remote care to the 120,000 patients IBD patients in the Netherlands3 could save approximately 878 tons CO2e per year.
This is equivalent to the annual carbon footprint of 47 average Dutch households, including housing, transport, clothing, food, and other goods.

Conclusion
IBD care has a substantial environmental impact. Remote care reduces outpatient visits and achieves notable emission savings, with even greater potential in larger countries than the Netherlands. Implementing remote monitoring with tight disease control in routine care can substantially reduce carbon emissions for IBD and other chronic disease populations.

References
1.de Jong MJ, van der Meulen-de Jong AE, Romberg-Camps MJ, Becx MC, Maljaars JP, Cilissen M, van Bodegraven AA, Mahmmod N, Markus T, Hameeteman WM, Dijkstra G, Masclee AAM, Boonen A, Winkens B, van Tubergen A, Jonkers DMAE, Pierik MJ. Telemedicine for management of inflammatory bowel disease (myIBDcoach): a pragmatic, multicentre, randomised controlled trial. Lancet. 2017;390(10098):959-68.
2.de Jong MJ, Boonen A, van der Meulen-de Jong AE, Romberg-Camps MJ, van Bodegraven AA, Mahmmod N, Markus T, Dijkstra G, Winkens B, van Tubergen A, Masclee AAM, Jonkers DMAE, Pierik MJ. Cost-effectiveness of Telemedicine-directed Specialized vs Standard Care for Patients With Inflammatory Bowel Diseases in a Randomized Trial. Clin Gastroenterol Hepatol. 2020;18(8):1744-52.
3.van Linschoten RCA, van Leeuwen N, van Klaveren D, Pierik MJ, Creemers R, Hendrix EMB, Hazelzet JA, van der Woude CJ, West RL, van Noord D. Prevalence, incidence and mortality of inflammatory bowel disease in the Netherlands: development and external validation of machine learning models. Submitted.