Carbon cost-effectiveness extends trial evaluation beyond clinical outcomes and financial cost, asking a broader question: which treatment pathway delivers the best value with the lowest environmental burden?
Within ECOPOP, the CCE project evaluates the environmental impact of treatment strategies for early colorectal cancer and integrates these data with clinical outcomes and cost. This means that the comparison between endoscopic and surgical approaches does not stop at recurrence, complications, or hospital stay.
It also asks what each pathway requires in terms of travel, materials, energy, follow-up care, and downstream resource use — and whether these differences matter when treatments offer similar outcomes.
Clinical trials usually compare effectiveness, safety, and cost. CCE adds a fourth dimension: environmental impact.
Healthcare is a major source of greenhouse gas emissions, and those emissions ultimately affect population health. If two interventions offer comparable oncological outcomes, but one generates less waste, requires fewer resources, or leads to a lower carbon footprint across the care pathway, that difference may matter clinically, economically, and systemically.
Clinical effectiveness and cost are commonly assessed, but the environmental consequences of care remain largely undefined within trial infrastructure.
Procedures, equipment, consumables, imaging, admissions, and follow-up all contribute to greenhouse gas emissions and resource use.
If two strategies offer similar results, the one requiring less travel, fewer materials, and lower downstream burden may represent better overall value.
CCE is intended not only to analyse ECOPOP interventions, but also to provide a practical model for integrating carbon cost-effectiveness into future clinical research.
Expected key results include carbon emissions associated with eFTR, ESD, and colorectal cancer surgery, integrated with clinical and economic analyses.
CCE uses life cycle assessment (LCA) methods to quantify greenhouse gas emissions across the treatment pathway. This includes the index intervention, supplies and instruments, additional procedures, and follow-up-related resource use. These data are then brought together with clinical trial outcomes and economic costs in a carbon cost-effectiveness framework.
CCE maps the materials, processes, and healthcare activities associated with endoscopic and surgical treatment strategies.
Audits across participating centres capture real-world procedural and pathway-level data rather than relying on abstract assumptions alone.
The package evaluates greenhouse gas emissions and identifies hotspots across the clinical care pathway.
Environmental outputs are assessed together with clinical outcomes and cost to support more complete treatment comparisons.
CCE is not about choosing the “greenest” option regardless of consequences. It is about identifying care that is both effective and sustainable. Even small differences in carbon emissions per patient can become meaningful when an intervention is used repeatedly across hospitals, regions, and healthcare systems.
This is why carbon cost-effectiveness is particularly relevant in ECOPOP. The project compares treatment pathways that may differ not only in invasiveness and patient burden, but also in resource intensity, waste generation, and downstream care requirements.
Data points for case report forms have been defined for the environmental endpoints.
Audit of endoscopic procedures is already underway, with surgical procedure audits planned to follow.
Upcoming work includes midpoint inventory update activities and continued environmental data collection across study pathways.
CCE will contribute a roadmap for integrating carbon cost-effectiveness into clinical research beyond ECOPOP itself.
Results from the CCE project may help clinicians, researchers, and health systems better understand how to compare treatments not only by outcome, but by the full burden they generate. In that sense, CCE is both an analysis package within ECOPOP and a methodological test case for future climate-conscious clinical research.
Questions about the package, collaboration, or environmental endpoint integration within ECOPOP can be directed to the project coordination team.
Questions about the package, collaboration, or environmental endpoint integration within ECOPOP can be directed to the project coordination team.
Contact the team