Clinical Scorecard: Achieving Long-Term Sustainability in the Management of Inflammatory Bowel Disease

At a Glance

Key Highlights

• IBD prevalence is rising worldwide, increasing pressure on healthcare systems and resources.
• Sustainable IBD care balances clinical effectiveness with affordability, equity, and environmental responsibility.
• Climate change impacts IBD development and exacerbations; healthcare contributes significantly to carbon emissions.

Guideline-Based Recommendations

Diagnosis

• Use validated biomarkers and imaging modalities (colonoscopy, CT, MRI, intestinal ultrasound) for proactive monitoring.
• Adopt essential diagnostics that are context-appropriate and resource-efficient.

Management

• Implement treat-to-target strategies aiming for steroid-free remission and prevention of cumulative bowel damage.
• Optimize biologic and small-molecule therapies including therapeutic drug monitoring.
• De-implement low-value practices and avoid clinical inertia in active disease.
• Promote strong care coordination and support transitions between pediatric and adult services.
• Integrate patient-reported outcomes into decision-making to enhance engagement and self-management.

Monitoring & Follow-up

• Intensify monitoring demands with efficient use of biomarkers and imaging to balance clinical benefits and resource use.
• Adopt telemedicine and green endoscopy practices to reduce environmental footprint.

Risks

• Stringent targets may increase treatment burden, costs, and adverse effects.
• Healthcare delivery contributes significantly to carbon emissions and environmental waste.
• Limited access to advanced therapies and diagnostics may widen inequities in care quality and outcomes.

Patient & Prescribing Data

IBD patients across diverse healthcare settings including low-resource regions

Responsible adoption of biosimilars and rational sequencing of therapies can improve sustainability and access.

Clinical Best Practices

• Balance clinical effectiveness with feasibility, affordability, and environmental sustainability.
• Build scalable, context-appropriate care models that reduce unwarranted variation.
• Coordinate multidisciplinary teams to optimize resource use and patient outcomes.
• Incorporate environmental impact considerations into clinical decision-making.
• Use telemedicine and reduce reliance on single-use materials to lower carbon footprint.

References

• Global burden and epidemiology of IBD
• Healthcare carbon footprint and environmental impact
• Climate change effects on IBD