Evaluating the carbon and economic impact of reusable airway devices in the NHS

How we worked with Brighton and Sussex Medical School

Unity Insights worked with Brighton and Sussex Medical School (BSMS) to analyse the environmental and economic case for transitioning from single‑use to reusable airway devices within NHS secondary care settings. The work directly supported wider NHS ambitions around net zero, sustainable procurement, and evidence‑based decision‑making.

Unity Insights were commissioned for our combined expertise in carbon impact analysis, health economic modelling, and analysis of sustainability interventions within healthcare. The analysis required robust, defensible modelling that could inform commissioning and investment decisions at trust, system, and national level, aligned with HM Treasury guidance and NHS sustainability priorities.

The carbon and economic impact of reusing traditionally single‑use airway devices (laryngeal blades, laryngeal mask airways [LMAs], and endotracheal tubes [ETTs]) using modern sterilisation methods was analysed. The analysis explored whether reusable airway devices could deliver meaningful carbon reductions while remaining economically viable for the NHS.

What did we do?

• Carbon impact analysis to estimate greenhouse gas emissions across manufacturing, transport, sterilisation, and disposal
• Health economic modelling and cost‑benefit analysis in line with HM Treasury’s The Green Book
• Scenario modelling at:
  • Secondary care site level
  • Integrated Care System (ICS) level
  • National NHS scale
• Sensitivity and uncertainty analysis (Monte Carlo simulation)
• Use of national datasets, procurement data, and expert clinical input to populate assumptions

This mixed‑methods approach allowed both environmental sustainability and financial viability to be examined under realistic implementation scenarios.

What were the impacts of the analysis?

Demonstrating robust, real‑world carbon impact modelling

The analysis showed that reusing airway devices can deliver consistent carbon reductions, even when accounting for sterilisation and transport:

• Reusable medical devices reduced carbon emissions by:
  • 0.40 kgCO₂e per use for laryngeal blades
  • 0.30 kgCO₂e per use for LMAs
  • 0.03 kgCO₂e per use for ETTs
• Carbon neutrality was achieved after:
  • 1 reuse for laryngeal blades
  • 2 reuses for LMAs
  • 5 reuses for ETTs

At scale, these reductions translated into millions of kgCO₂e avoided annually, equivalent to hundreds of thousands of car miles removed from the road:

• A net reduction in kgCO₂e of:
  • 1.2 million for laryngeal blades (or 320,000 miles by car)
  • 6.4 million for LMAs (or 1,770,000 miles by car)
  • 0.2 million for ETTs (or 51,000 miles by car)

Quantifying the economic case for sustainable procurement

The health economic analysis demonstrated a strong but nuanced economic case:

• Laryngeal blades showed a clear financial benefit
  • 5‑year benefit-cost ratio (BCR): 2.5
• LMAs demonstrated a modest but positive return
  • 5‑year BCR: 1.2
• ETTs were not cost‑effective under current sterilisation assumptions
  • 5‑year BCR: 0.2

Overall, these findings demonstrate an evident positive economic case for implementation of reusable laryngeal blades using the UVC sterilisation method, a lesser but still positive case for the LMA devices, and a contrary case for ETTs under the current model assumptions and sterilisation method.

Why does this matter?

This analysis gave the client a clear, evidence‑based decision framework to support sustainable innovation in airway management. Specifically, it:

• Identified which devices were suitable as reusable devices, and which required further development
• Highlighted sterilisation cost and throughput as the key levers for improving value
• Provided scalable evidence to inform investment decisions at trust, ICS, and national level
• Strengthened the case for real‑world pilots, enabling future funding and implementation

By combining environmental and economic evidence, the analysis enabled stakeholders to move beyond sustainability ambition toward practical, implementable change: supporting NHS net zero goals without compromising patient safety or financial stewardship.

Read the full report here.