Licensed ready-to-use gemcitabine bags cut carbon emissions versus in-house vial compounding

Introduction
Hospital compounding of gemcitabine from glass vials generates additional greenhouse gas emissions linked to glass production, single-use devices and clinical waste incineration. Licensed ready-to-use (rtu) polypropylene infusion bags may reduce this footprint. we compared the cradle-to-grave carbon impacts of both supply chains using two independent life-cycle tools.

Materials and methods
A prospective assessment following iso 14040 inventoried, for each dose (1200–2200 mg), the
contributions of active pharmaceutical ingredient (api), excipients, packaging, upstream and downstream transport, formulation losses and end-of-life. ancillary consumables needed only for in-house compounding (spike, gauze, syringes 5–50 ml) were included. emissions were Calculated using ecovamed^© 2025, carebone^© v2.3 (aphp), and in-house hospital data. pooled results per dose were obtained by averaging the three methods and computing standard deviation.

Results
Compared to conventional vial-based preparation, licensed rtu bags saved on average :
0.82 ± 0.44 kg eqco₂ at 1200 mg,1.01 ± 0.62 kg at 1400 mg,1.18 ± 0.80 kg at 1600 mg,
1.35 ± 0.94 kg at 1800 mg, 1.49 ± 1.07 kg at 2000 mg and 1.70 ± 1.26 kg at 2200 mg.
These results were consistent across both life-cycle methods and include the impacts of all ancillary consumables. in relative terms, carbon savings per dose reached between 40% and 60% compared to traditional preparation. major contributors were the replacement of heavy glass packaging with lightweight plastic (≈42%), elimination of multiple single-use sterile devices (≈19%) and lower volumes of clinical waste incinerated at end-of-life (≈14%). as the dosage increases, the number of glass vials and associated disposables required rises disproportionately, further amplifying the environmental benefit of switching to rtu formats.

Conclusion
Replacing glass vials with ready-to-use gemcitabine bags consistently reduces environmental impact, with up to 1.7 kg eqco₂ avoided per dose administered. to contextualise, this potential economy corresponds to the emissions generated by a 15-minute car journey in an average petrol vehicle, or the full daily carbon footprint of a person living in a low-emission european household. with hundreds of doses delivered per year in a single hospital, the cumulative savings rapidly exceed one tonne of co₂ equivalents, making the adoption of rtu bags a pragmatic, scalable and immediately available decarbonisation strategy. in oncology pharmacy, where safety and efficiency are paramount, integrating such climate-conscious formats enables institutions to align environmental goals with operational and clinical priorities, without compromising patient care or workflow.