Waste Management 175 (2024) 1–11

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Waste Management
journal homepage: www.elsevier.com/locate/wasman

Research Paper

Life cycle assessment of pharmaceutical packaging addressing

end-of-life alternatives
Fabiana Bassani a, b, *, Carla Rodrigues a, Fausto Freire a
a
Univ Coimbra, ADAI, Department of Mechanical Engineering, Polo II, Rua Luís Reis Santos, 3030-788 Coimbra, Portugal
b
Federal Institute of Education, Science and Technology of Pará - IFPA, Conceição do Araguaia, Brazil

A R T I C L E I N F O A B S T R A C T

Keywords: Pharmaceutical packaging waste has increased due to a higher global demand for pharmaceutical products,
Disposal leading to more waste generation and associated environmental impacts. The main goal of this article is to
Environmental impact present a cradle-to-grave life cycle assessment of pharmaceutical packaging, evaluating end-of-life (EoL) alter­
Incineration
natives, aiming to identify hotspots and opportunities for improvement. A life cycle model was implemented for
Landfill
three types of pharmaceutical packaging (blisters, sachets, bottles; 23 packaging). The functional unit is the
Medicine
Recycling storage and delivery of medicines containing the same active pharmaceutical ingredient, dosage, and amount of
Take-back medicines. Two EoL analyses were performed: 1) compare take-back (recycling and incineration) with domestic
Waste waste collection (landfill or incineration); and 2) assess different EoL situations of pharmaceutical packaging in
Europe. A life cycle impact assessment was performed for 13 categories. Analysis 1 shows that take-back presents
lower environmental impacts than domestic waste collection for seven out of 13 categories due to paper and glass
recycling benefits. Analysis 2 shows that in the take-back, higher amounts of packaging are recycled or incin­
erated, which leads to lower EoL impacts. A sensitivity analysis was performed to evaluate the influence of
parameters and assumptions in packaging EoL impacts. Packaging production contributes significantly to life
cycle impacts, followed by transportation, EoL, and packing process. Ecodesign initiatives are recommended,
such as packaging with less material and volume, using materials with lower impacts to significantly reduce the
impacts of pharmaceutical packaging.

1. Introduction
Pharmaceutical packaging waste has been increasing due to a higher
global demand for pharmaceutical products (Mitkidis et al., 2022).
Pharmaceutical packaging in Europe is commonly discarded with do­
mestic waste, ending up in sanitary landfills or incineration (Amaral and
Fop, 2013; Bio Inteligence Service, 2013; EEA, 2010). It is important to
reduce the environmental impacts of pharmaceutical packaging; how­
ever, Life Cycle Assessment (LCA) has been rarely employed to phar­
maceutical packaging, even fewer studies addressed the end-of-life
(EoL). Exceptions are discussed in the next paragraph.
Dhaliwal et al. (2014) analyzed different EoL treatments (incinera­
tion, landfill and recycling) for two types of bottles (plastic and glass)
and concluded that recycling presents lower impacts than landfill or
incineration. The results focused on the packaging alternatives, with few
details on the contribution of the different EoL treatments. Navajas et al.
(2017) analyzed two glass and polymer bottles discarded to be landfilled
or recycled, showing that the EoL does not have a significant contribu­
tion to life cycle impacts (due to the benefits from recycling). Belboom
et al. (2011) performed LCA to compare glass vials with polymer vials
addressing the EoL, showing that polymer vials have lower environ­
mental impacts than glass vials.
The main goal of this article is to present a comprehensive cradle-to-
grave LCA of different types of pharmaceutical packaging for medicines
commonly sold in community pharmacies, evaluating EoL alternatives
for pharmaceutical packaging, aiming to identify hotspots and oppor­
tunities for improvement. Two analyses are performed to assess EoL
alternatives, as follows. Firstly, a comparative analysis of a take-back
scheme (in the scope of the extended producer responsibility (Monier
et al., 2014)) versus domestic waste collection. Secondly, different EoL
situations of pharmaceutical packaging in Europe are assessed to eval­
uate the contribution of the various life cycle phases and processes, and
discuss EoL impacts within a life cycle perspective. In addition, a
sensitivity analysis evaluates the influence of parameters and

* Corresponding author at: Univ Coimbra, ADAI, Department of Mechanical Engineering, Polo II, Rua Luís Reis Santos, 3030-788 Coimbra, Portugal.
E-mail address: fabiana.bassani@dem.uc.pt (F. Bassani).

https://doi.org/10.1016/j.wasman.2023.12.022
Received 11 February 2023; Received in revised form 27 November 2023; Accepted 11 December 2023
Available online 15 December 2023
0956-053X/© 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
F. Bassani et al. Waste Management 175 (2024) 1–11

assumptions in packaging EoL impacts. This article expands on a pre­ considered a production location in the center of Europe (in the Paris-FR
vious cradle-to-gate (pharmacy) LCA of pharmaceutical packaging region) to a distribution center in Portugal (distance of 1500 km) and
(Bassani et al., 2022a). transportation to pharmacies (100 km). Detailed information is docu­
The main novelty of this article is to analyze the pharmaceutical mented in SM (Section S2.1 of SM).
packaging life cycle (cradle-to-grave), evaluating EoL alternatives for The most common options available in Europe for consumers to
pharmaceutical packaging, and shedding light on practices with better discard pharmaceutical packaging after use are assessed: take-back and
environmental performance. This article highlights how decisions per­ domestic waste collection (Amaral and Fop, 2013; Mehtonen et al.,
formed in the early stages of design, namely choice of materials or type 2020; Siegert et al., 2020). Take-back is a scheme (available in some
of packaging, can significantly influence packaging life cycle impacts, countries, such as France, Netherlands, Portugal and Spain) (Amaral and
including EoL treatments. It provides insights for the pharmaceutical Fop, 2013) in which consumers discard used pharmaceutical packaging
sector to improve packaging, reducing the impacts from the packaging in a collection site (pharmacies) for valorization (Cook et al., 2012). In
design phase till the EoL. domestic waste collection, pharmaceutical packaging is discarded
together with domestic waste, commonly disposed of in landfills or
2. Methods incineration plants, depending on the treatment available in each Eu­
ropean country or region (Siegert et al., 2020).
Life Cycle Assessment (LCA) methodology was implemented Two types of analyses were implemented for EoL alternatives and
following the international standards (ISO 14040, 2006; ISO 14044, situations for pharmaceutical packaging in different European countries.
2006), including goal and scope definition, implementation of life cycle Analyses 1 and 2 are summarized in Tables 1a and 1b, respectively.
models and inventories for pharmaceutical packaging to assess envi­ Analysis 1 compares take-back (for recycling and incineration) with
ronmental impacts for thirteen categories (global warming, abiotic domestic waste collection for landfill or incineration with energy re­
depletion – fossil fuel, acidification, ozone depletion, abiotic depletion – covery. The take-back scheme implemented in Portugal was investigated
mineral and metal, particulate matter, eutrophication freshwater, since primary data for pharmaceutical packaging was available
eutrophication marine, eutrophication terrestrial, ionizing radiation, (Valormed, 2020). Take-back includes the delivery of used packaging by
photochemical ozone formation, land use and water use), selected based consumers in any pharmacy, followed by transport to a distribution
on European recommendations (European Commission, 2021) and center, using the empty space available in the return trip of medicine
Product Environmental Footprint Category Rules (PEFCR) of pharma­ distribution. Afterwards, packaging waste is transported (in specific
ceutical products and processes (Siegert et al., 2019). The Circular boxes) to a national sorting center for final treatment separation:
Footprint Formula (CFF) was used to calculate EoL impacts, following incineration (with energy recovery) for plastic, blisters and sachets; and
the European recommendation for the Environmental Footprint method recycling for paper (secondary packaging and information leaflet) and
(European Commission, 2021). glass.
Analysis 2 assesses different EoL situations in Europe. Three situa­
2.1. Goal and scope definition tions for pharmaceutical packaging were modeled: i) countries with
Higher Recycling & Incineration shares (High-RI); ii) countries with
A cradle-to-grave life cycle model for pharmaceutical packaging
exploring end-of-life (EoL) alternatives was developed to assess the
impacts associated with different pharmaceutical packaging for four Table 1
medicines for human consumption commonly sold in community Pharmaceutical packaging EoL (end-of-life).
pharmacies in Europe. EoL alternatives and various EoL situations of a) Analysis 1: EoL alternatives
pharmaceutical packaging representing different realities in Europe Description Take-back Domestic waste
were investigated. Three types of pharmaceutical packaging were collection
analyzed: blister, bottle and sachet, the most common types of phar­
Recycling (paper, glass) Landfill Incineration
maceutical packaging commercialized in pharmacies (Credence & incineration (plastic, (%) (%)
Research, 2017). blister, sachet) (%)
The functional unit is the storage and delivery of medicines con­ Take-back 100 0 0
taining the same active pharmaceutical ingredient (API), dosage, and Landfill 0 100 0
amount of medicines for sale in community pharmacies. It addresses the Incineration 0 0 100
entire life cycle of a complete packaging consisting of primary packaging b) Analysis 2: EoL situations for selected European countries
(in contact with the medicine), secondary packaging (containing the
Description Take-back Domestic waste
primary packaging), and information leaflet. The functional unit permits collection
the comparison of alternative types of packaging, each one for the same
Recycling (paper, glass) Landfill Incineration
medicine, and alternative packaging EoL, aiming to draw conclusions & incineration (plastic, (%) (%)
for the pharmaceutical packaging sector. blister, sachet) (%)
Twenty-three packaging options for four medicines, named “O” (#5
Countries with Higher 52 1 47
options), “L” (#4 options), “P” (#6 options), and “I” (#8 options), were Recycling &
selected, with different types (blister, bottle and sachet), materials, Incineration shares
weights and volumes. The options for each (of the four) medicine have (High-RI)*
the same API, dosage and amount of drug. The main characteristics of Countries with Higher 14 83 3
Landfill share (High-L)
packaging are listed in Tables S1, S2 and S3 of Supplementary Material **

(SM, Section S2.1 of SM). Various materials for blisters (PVC-Alu, PVC/ Portugal (PT) ***
15 64 21
PVDC-Alu and OPA/Alu/PVC-Alu), bottles (HDPE and glass, with PP *
Sweden, Germany, Denmark and Finland: shares are the arithmetic average
cap) and sachets (HDPE/Alu/ HDPE/paper) were considered. The vol­
(Eurostat, 2020).
ume and weight of packaging among alternatives for the same medicine **
Malta, Cyprus, Romania and Greece: shares are the arithmetic average
vary up to 8 and 3.5 times, respectively. The selection process as well as (Eurostat, 2020).
more details of the packaging are presented in Bassani et al., (2022a). A ***
Take-back share based on primary data for Portugal (Valormed, 2020);
representative scenario in Europe was implemented for cradle to phar­ domestic waste disposal shares for 2019 (APA - Portuguese Environment Agency
macies life cycle model, based on Bassani et al., (2022a,b). It was et al., 2020).

2
F. Bassani et al.
Higher Landfill share (High-L); and iii) Portugal (PT) (Table 1b). High-RI
and High-L are based on domestic waste disposal (data from 2019) for
four European countries with higher recycling and incineration shares
(Sweden, Germany, Denmark and Finland) and four countries with
higher landfill shares (Malta, Cyprus, Romania and Greece), respec­
tively, based on Eurostat (2020), since specific data for final disposal of
pharmaceutical packaging was not available. The situation in Portugal is
based on primary information for the take-back scheme (Valormed,
2020), as well as domestic waste disposal (APA - Portuguese Environ­
ment Agency et al., 2020).
Fig. 1 presents the system boundaries and the main processes of the
life cycle model, which include materials production, packing process,
transport to distribution centers and to pharmacies, transportation of
pharmaceutical packaging waste, and end-of-life disposal. For analysis
1, the system boundaries include the EoL take-back and domestic waste
collection (landfill or incineration) as alternatives to packaging after
discarded by consumers; for analysis 2, it includes the EoL situations in
Europe with different shares presented in Table 1. The Product Envi­
ronmental Footprint Category Rules (PEFCR) factors were used to guide
the allocation of benefits and burdens from recycling ((A = 0.2) and
incineration (B = 0) of pharmaceutical packaging and a second product
system (detailed in section 2.2. Life cycle inventory analysis). The
medicine production is out of the scope and the use of packaging is
negligible.
2.2. Life cycle inventory analysis
The inventory of packaging production, packing process and trans­
portation to pharmacies (cradle-to-gate including distribution) is sum­
marized in Table S4 of SM, based on Bassani et al., (2022a,b). The bill of
materials per functional unit of the 23 selected complete packaging is
Fig. 1. Life cycle of pharmaceutical packaging: system boundaries and main processes.
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Waste Management 175 (2024) 1–11
detailed in SM (Tables S1, S2 and S3).
The life cycle inventory (LCI) for the EoL analyses include trans­
portation and EoL treatment. Transportation from distribution centers to
the sorting center, in the take-back scheme, is made by truck (one-way,
with 21 t and 25 m3 of load occupancy) using specific boxes (capacity of
4.9 × 10− 2 m3) to carry the packaging waste, modeled for three dis­
tances (100, 200 and 400 km). The quantity of packaging transported by
truck depends on packaging volume. Fuel consumption was calculated
considering the maximum volume capacity for the distances considered,
modeled based on Keller (2010). Detailed information regarding the
packaging transported in the vehicle is documented in SM, Table S5. An
average electricity consumption at the sorting center was estimated at
23 Wh/kg packaging, calculated based on data provided (Wh/kg of
waste – year 2017). The European electricity mix was considered using
the ecoinvent v.3.6 database. For transportation from the sorting center
to the treatment (recycling or incineration), a 16–32 t truck (50 km).
Waste treatment was modeled using the ecoinvent v.3.6 database
(Hischier, 2007), considering incineration processes of specific pack­
aging materials. Incineration process includes heat and electricity con­
sumption, waste burning in a grate-type furnace, electricity and heat
generation (depending on the material), slag (gray), and effluents.
Recycling includes the benefit associated with the avoided burdens from
virgin material production. LCI processes assumed for incineration and
recycling are presented in SM (Table S6).
A municipal waste collection truck (21 t) was considered for the
domestic waste collection situation, for packaging transportation from
disposal (waste bin) to landfill or incineration, considering three dis­
tances (50, 100 and 150 km). Packaging treatment in landfill and
incineration was modeled using processes available in the ecoinvent
v.3.6 databases (Hischier, 2007) for each material, considering the Eu­
ropean average for energy consumption. Detailed information of the
F. Bassani et al.
specific ecoinvent processes is presented in SM (Table S6). End-of-life
modelling and assumptions can vary considerably, particularly
regarding the waste treatment process selected, a sensitivity analysis
was performed considering alternative waste treatment processes and
model assumptions (detailed on section 2.3).
The Circular Footprint Formula (CFF) (European Commission, 2021)
was used to calculate the EoL impacts and benefits of pharmaceutical
packaging disposal. Energy recovered from incineration used in the
same process is considered burden-free. Additional energy produced
was assumed as an environmental credit for the packaging system (B =
0), as recommended by European Commission (2021) to consider waste-
to-energy burdens and avoided primary production. Transportation
impacts from disposal to EoL treatment were accounted for the pack­
aging system. Avoided burdens from paper and glass recycling (in the
take-back scheme) were accounted with an allocation factor of 80 % (A
= 0.2) (European Commission (2021), considering the incentive for
pharmaceutical packaging recovery from take-back under the extended
producer responsibility policy. Primary materials are 100 % virgin.
Quality factor of recycled content (Qsout/Qp = 1), and the other variables
considered in the CFF calculations, are presented in SM (Equation S1,
Tables S7 and S8).
Different allocation factors (for burdens and benefits) can affect re­
sults and compromising potential recommendations (Allacker et al.,
2017). The use of PEFCR-recommended CFF factors was discussed in the
literature due to the difficulty of representing multifunctional systems of
different products, and was pointed out that these factors should be used
with caution as they are highly dependent on market fluctuations or
corrections (e.g., taxes, subsidies), which can be a weakness, without
direct relation to material quality (Ekvall et al., 2021; Tonini et al.,
2022). To address the uncertainty on these factors, alternative allocation
factors of the circular footprint formula are assessed in a sensitivity
analysis (detailed in section 2.3).
2.3. Sensitivity analysis
A sensitivity analysis was performed in the EoL modelling to address
parameter and scenario uncertainties (comparing alternative scenarios
to the base case scenario), evaluating the influence of allocation factors
and waste treatment assumptions in packaging EoL impacts. Table 2
presents the alternative scenarios assessed: i) base case; ii) alternative
allocation factors of the circular footprint formula; and iii) alternative
waste treatments (based on Cook et al (2012)).
The alternative CFF factors implemented are: i) an allocation factor
Table 2
Sensitivity analysis scenarios.
Scenario Description
I) Base-case Circular footprint formula factors recommended by
Product Environmental Footprint Category Rules
(PEFCR: A = 0.2; Qs/Qsout = 1; B = 0
Average transportation distance
Waste treatment modelled by type of material
II) Alternative allocation Circular footprint formula factors considered: A = 0.8;
factors Qs/Qsout = 0.2; and B = 0.8 (for incineration of
domestic waste collection)
Average transportation distance
Waste treatment modelled by type of material
III) Alternative waste For take-back: recycling (paper and glass) and
treatment model hazardous waste incineration (for all the other
materials)
For domestic waste collection: landfill of domestic
waste or incineration of domestic waste (for all
materials)
Circular footprint formula factors recommended by
PEFCR: A = 0.2; Qs/Qsout = 1; B = 0
Average transportation distance
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Waste Management 175 (2024) 1–11
of 20 % (A = 0.8), assuming that the market price of recycled material is
lower than virgin material; ii) a factor of 0.2 (low quality) for the quality
of the outgoing recyclable material (QSout/QP); iii) an allocation factor of
20 % (B = 0.8) for the incineration process, representing the share of
responsibility between the packaging producer and the waste treatment
manager.
The alternative waste treatments implemented are take-back
modeled considering a generic hazardous waste incineration process
(instead of specific processes for each packaging material), as well as
domestic waste collection modeled considering generic landfill and
incineration in domestic solid waste processes (instead of specific pro­
cesses for each packaging material).
This sensitivity analysis is focused on end-of-life (zooming in from
the cradle-to-grave impacts). Previous work by the authors (Bassani
et al., (2022a,b)) assessed influential parameters associated with the
other life cycle phases (cradle-to-distribution to pharmacies).
3. Results
This section presents the life cycle impact assessment for three
selected environmental categories: global warming, abiotic depletion -
fossil fuel and acidification for the 23 alternative pharmaceutical
packaging of the four medicines O, L, P and I. Detailed results and dis­
cussion for the other 10 categories are documented in SM. Section 3.1
presents a contribution analysis (breakdown of results by material or life
cycle phase) for the end-of-life (EoL) alternatives of analysis 1
(comparing take-back with domestic waste collection) and section 3.2,
for different EoL situations in Europe - analysis 2. Section 3.3 presents
the sensitivity analysis results for the alternative scenarios: I) base case;
II) alternative CFF allocation factors; and III) alternative waste
treatments.
3.1. Cradle-to-grave considering end-of-life alternatives (analysis 1)
Fig. 2a presents the cradle-to-grave environmental impact results
and Fig. 2b zooms in on the EoL alternatives for take-back (recycling and
incineration) and domestic waste collection (landfill or incineration) of
the 23 pharmaceutical packaging analyzed.
Results show that packaging with more compact formats (less weight
and volume) can lead to lower impacts in a life cycle perspective.
Additionally, disposal in take-back scheme (instead of domestic waste
collection) can reduce the pharmaceutical packaging EoL impacts for all
packaging types (blister, bottle and sachet) and materials used, due to
recycling and valorization of materials.
The cradle-to-grave analysis shows that the production phase has the
highest contribution to life cycle impacts, followed by transport, end-of-
life treatment and packing process. The primary packaging production
has a high contribution (up to 93 %) to life cycle impacts, especially
oversized packaging (e.g., blisters LB-02 and PB-02, and sachets), due to
the high amount of material used, particularly aluminum, which have
high impacts. Blisters using PVC-Alu have the lowest life cycle impacts,
followed by PVC/PVDC-Alu and OPA/Alu/PVC. The production of sec­
ondary packaging (especially larger packaging, OB-02, LB-02, PB-02 and
IS-06) and information leaflet has a high contribution (up to 72 % and
40 %, respectively) to life cycle impacts, particularly for land use and
water use, due to virgin paper production. A detailed discussion of re­
sults regarding the packaging type and materials is presented in Bassani
et al., (2022a).
Transportation contributes up to 27 % to packaging life cycle impacts
(particularly for abiotic depletion - fossil fuel, global warming and ozone
depletion (Fig. S1b of SM)). Transportation impacts are also higher for
larger packaging (OB-02, LB-02, PB-02 and IS-06, see Fig. 2a), showing
that reducing packaging dimensions also contributes to reducing
transport (distribution and to treatment) impacts. Similarly, the
contribution of the packing process is also higher for packaging with
more material (due to emissions from incineration of production losses
F. Bassani et al. Waste Management 175 (2024) 1–11

Fig. 2. Life cycle impact assessment of a complete packaging (P) of medicines O (#5 options), L (#4 options), P (#6 options), and I (#8 options), comparing two end-
of-life (EoL) alternatives: take-back (recycling and incineration) and domestic waste collection (landfill or incineration). 2a: Cradle-to-grave; 2b: Zoom in on the
EoL phase.

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F. Bassani et al. Waste Management 175 (2024) 1–11

Fig. 2. (continued).

during packing), showing again that smaller packaging contributes to contributes up to 30 % of life cycle impacts. Take-back presents the
better life cycle performance than oversized packaging). lowest impacts for most environmental categories (seven out of 13),
Fig. 2b zooms in on the EoL alternatives and shows that the EoL mainly for eutrophication marine, particulate matter and water use

6
F. Bassani et al.
(Fig. S1b of SM), due to the benefits from recycling (glass, secondary
packaging and information leaflet). For domestic waste collection,
landfill presents higher impacts (up to 230 and 38 times higher than
take-back and incineration, respectively) for six out of 13 categories due
to the chemicals from liquid leachate and gas emissions from the
landfilling.
Incineration has higher impacts (up to 60 and 32 times higher than
take-back and landfill) for five categories, especially for acidification,
due to emissions from incineration of primary packaging materials (PVC
and PVDC of blisters and HDPE of bottles and sachets) and water con­
sumption in the incineration process (wet flue gas scrubber). On the
other hand, incineration has lower impacts than landfill (0.2–180 times)
for six environmental categories (mostly for fossil fuel and ozone
depletion) due to the benefits of energy recovery (electricity and heat)
from materials combustion. It stands out that packaging collection
(transport) has a high contribution in all EoL alternatives, particularly
for fossil fuel depletion, photochemical ozone formation and particulate
matter (up to 95 % of EoL impacts – Fig. 2b, and Fig. S1b of SM) due to
emissions from diesel (production and burning).
Smaller packaging using the same material (e.g., OB-03 and OB-04
Fig. 3. Life cycle impact assessment of a complete packaging of medicines O (#5 options), L (#4 options), P (#6 options), and I (#8 options) for three end-of-life
(EoL) situations in Europe: Higher Recycling & Incineration shares (High-RI), countries with Higher Landfill share (High-L) and Portugal (PT)). 3a) Cradle-to-grave;
3b) Zoom in on the EoL phase.
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Waste Management 175 (2024) 1–11
for medicine O; and IB-01 for medicine I) present lower impacts than
oversized packaging (OB-02 and IB-04) for all EoL alternatives. Excep­
tionally, smaller blisters (using a higher amount of PVC) present higher
incineration impacts (particularly for three categories, mineral and
metal depletion, water use and ozone depletion – Fig. S1b of SM) due to
the high impacts of PVC incineration.
The results show that disposal in take-back present lower impact
than domestic waste collection (incineration and landfill) in most cat­
egories analyzed for all packaging types (blister, bottle or sachet).
Regarding alternative packaging (with different materials and types) for
the same medicine, the results are highly dependent on the EoL alter­
native, and the amount and type of materials used. In take-back, glass
bottle of medicine P (PBo-06) has lower impact than plastic bottle (PBo-
05 - up to 28 times lower impact) and blisters (up to 13 times lower
impact than PB-01 to PB-04), due to the benefits of glass recycling. A
brief discussion on packaging type results considering EoL alternatives is
presented in the SM (section S3.1).
Trade-offs between life cycle phases occur depending on the type of
material, in which OPA/Alu/PVC has higher production impacts
(compared to PVC and PVC/PVDC) and lower EoL impacts. Likewise, a
F. Bassani et al.
Fig. 3. (continued).
higher amount of material in the secondary packaging and information
leaflet has higher production impacts but may have environmental
benefits if recycled at the EoL.
3.2. Cradle-to-grave considering different end-of-life situations (analysis
2)
Fig. 3a presents the cradle-to-grave impacts of the 23 pharmaceutical
packaging and Fig. 3b zooms in on the EoL phase for three different
situations in Europe. Results of analysis 2 also show that packaging with
more compact formats (less weight and volume) can lead to lower im­
pacts in a life cycle perspective. Additionally, higher amounts of valo­
rized packaging in take-back schemes, either recycled or incinerated,
reduce EoL impacts.
Cradle-to-grave results shows that packaging material production is
the phase with the highest life cycle impacts (also showed in analysis 1).
Contribution of materials and process to the life cycle impacts are
summarized in Table S9 of SM. It can be noted that smaller packaging
present better life cycle performance than oversized packaging.
Results show that EoL impacts highly depend on the quantity of
packaging valorized in the take-back scheme and incineration, due to
the benefits accounted from recycling and energy recovery. Higher
amount of material valorized in High-RI (countries with Higher Recy­
cling & Incineration shares) leads to lower EoL impacts of
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Waste Management 175 (2024) 1–11
pharmaceutical packaging. The impacts of High-L (countries with
Higher Landfill shares) are higher for seven (out of 13) environmental
categories (global warming, particulate matter, marine and terrestrial
eutrophication, photochemical ozone depletion and land use – Fig. 3b,
and S2b of SM), as well as in PT (Portugal) situation, for four categories
(abiotic depletion - fossil fuel, acidification, eutrophication freshwater
and ionizing irradiation), due to the high percentage of pharmaceutical
packaging landfilled. Exceptionally, High-RI has higher impacts than
High-L and PT for ozone depletion and abiotic depletion - mineral and
metal (Fig. S2b of SM), due to high emissions from incineration and
transport to EoL treatment facility, respectively. A detailed discussion on
each packaging alternative results for the four medicines is presented in
the SM (section S3.2).
3.3. Sensitivity analysis for the end-of-life scenarios
Fig. 4 presents the end-of-life impacts (global warming, abiotic
depletion – fossil fuel and acidification) of a complete packaging
(medicines O, L, P, I), incorporating a sensitivity analysis for the sce­
narios: I) base-case (CFF recommended factors); II) alternative CFF
allocation factors; and III) alternative waste treatments. Detailed results
for all categories are available in the SM (Tables S10-S22).
Results for global warming show that waste incineration assuming
alternative allocation factors (B = 0.8 for incineration of domestic waste
F. Bassani et al. Waste Management 175 (2024) 1–11

Fig. 4. End-of-life impacts for a complete packaging of medicines O (#5 options), L (#4 options), P (#6 options), and I (#8 options), incorporating sensitivity
analysis for the following scenarios: I) base-case (circular footprint formula (CFF) recommended factors); II) alternative CFF allocation factors; and III) alternative
waste treatments.

Fig. 5. Sensitivity analysis: ratio of alternative scenarios results (II - alternative allocation factors and III - alternative waste treatments) to base case results.

9
F. Bassani et al.
collection) has the lowest impacts for most packaging. The glass bottle
(PBo-06) has lower impacts in take-back considering the alternative
waste treatment. For abiotic depletion – fossil fuel and acidification, the
alternative waste treatment in take-back presents the lowest impacts for
all packaging.
Results of the sensitivity analysis on the alternative CFF allocation
factors show that, when decreasing the benefits allocated to the pack­
aging (i.e., reducing the allocation factor in recycling from 80 % to 20 %
and in incineration of domestic waste collection from 100 % to 20 %), as
well as the quality of the outgoing recyclable material (from 1 to 0.2),
the impacts of the take-back alternative increase up to 30 % (except for
the glass bottle, whose impacts increase 40–150 %), while, for inciner­
ation of domestic waste collection, impacts decrease up to 8 % for most
environmental categories. However, regardless of the allocation factors
assessed, take-back is the alternative with the lowest impact for seven
(out of 13) categories. Additionally, when considering an allocation
factor of 20 % (B = 0.8) for incineration in domestic waste collection and
maintaining the PEFCR-recommended values for take-back scheme (in
the scope of the extended producer responsibility policy), take-back
remains the EoL alternative with lower impacts.
Fig. 5 shows sensitivity analysis for global warming, using a ratio of
results of alternative scenarios to base-case, to understand the influence
of allocation factors and waste treatment assumptions. The alternative
waste treatment scenario presents a ratio from 0.4 to about 4 times for
take-back, 0.3 to 1.3 for incineration, and 1 to 1.3 for landfill. The
highest ratio differences are for packaging with higher quantity of ma­
terial, particularly paper and glass due to credits (high share) considered
in the base case. Alternative allocation factors have a lower influence on
the results (0.3 to 1.3 for incineration, 1 to 1.3 for take-back).
4. Discussion
This section discusses the results presented in section 3 and provides
recommendations for pharmaceutical packaging. Assumptions and
limitations are also discussed, namely for the sensitivity analysis per­
formed in the end-of-life modelling.
The results calculated for the pharmaceutical packaging system with
PEFCR-recommended values for the CFF factors benefit the take-back
scheme, by allocating high benefits (80 % for recycling, 100 % for
incineration) to the system that provides the EoL material, promoting
the extended producer responsibility policy. For incineration, in the
domestic waste collection scheme, the reference value (B = 0) benefits
the packaging system by allocating 100 % of benefits and burdens. The
sensitivity analysis shows that, regardless of the allocation factors used,
take-back is the EoL alternative with lower impacts for pharmaceutical
packaging.
The values of the CFF factors are highly dependent on the type of
material, market price (compared with the virgin material) and lower
heating value (for incineration). PEFCR-recommended values for the
CFF factors benefit products that at the EoL dispose of large amounts of
paper or glass for recycling, with market prices similar to virgin (pri­
mary) material, which is the case of pharmaceutical packaging. Never­
theless, for other products and contexts (e.g., low quality of recycled
material or low heating value), misleading results can risk discouraging
the best practices in the scope of shared responsibility of the waste
producer and waste treatment manager.
It can be noted that the waste treatment adopted highly influences
the EoL impacts, particularly if benefits are considered (e.g. from
incineration or recycling). Modelling choices, particularly if a specific
waste treatment process (by type of material) is considering instead of a
generic process (mix of municipal solid waste) can also be highly
influential. A generic process usually overestimates impacts, as it con­
siders a mix of materials (including organic), for instance, plastics (such
as PVC) have lower impacts (in most categories) in municipal solid
waste incineration (by type of material) than adopting generic hazard­
ous waste incineration.
10
Waste Management 175 (2024) 1–11
Cradle-to-grave impacts of pharmaceutical packaging show that
decisions made in the packaging design stage (e.g., dimensions, pack­
aging type and materials) can reduce life cycle impacts, including also
the EoL, depending on the choice of EoL treatment. Lower use of ma­
terial (packaging with lower size) and material with lower environ­
mental impact improve the environmental performance of packaging.
Trade-offs between life cycle phases occur depending on the type of
material, for example, OPA/Alu/PVC has higher production impacts
(compared to PVC and PVC/PVDC) and lower EoL impacts. In addition,
a higher amount of material (paper) in the secondary packaging and
information leaflet has higher production impacts but has environ­
mental benefits if recycled at the EoL.
Additionally, recommendations resulting from this research can be
provided to guide the pharmaceutical sector in improving the environ­
mental performance of packaging: i) collection schemes for pharma­
ceutical packaging should be encouraged to promote material recovery
at the EoL; ii) guidance for users should be promoted, to dispose of
pharmaceutical packaging in specific collection points, facilitating
routing to appropriate EoL treatments; iii) packaging ecodesign initia­
tives (such as, reduce the weight of packaging and use materials with
lower environmental impacts) must be a priority for pharmaceutical
companies, since there are large opportunities to improve the environ­
mental performance of pharmaceutical packaging, from material selec­
tion to EoL.
5. Conclusions
This article shows that decisions made in early design stages can
have a high influence in all life cycle phases, from production to EoL, for
instance, materials with lower production impacts (such as PVC-Alu for
blisters), may not be recycled, ending up being landfilled (depending on
the location).
Drawing on the results, it can be concluded that packaging with less
material and volume, using materials with lower impacts, and with EoL
valorization significantly reduce the life cycle impacts of pharmaceutical
packaging. The selection of packaging with the best environmental
performance for each medicine combines the choice of type, volume,
amount and materials used, as well as EoL treatment.
The comparative analysis of EoL alternatives (analysis 1) shows that
take-back scheme presents lower environmental impacts than waste
domestic collection (incineration followed by landfill). Results for the
disposal situations in Europe (analysis 2) show that higher amounts of
valorized packaging in take-back schemes (either recycled or inciner­
ated), lead to lower EoL impacts. However, EoL-related decisions are
highly dependent on the user behavior and final treatment, which de­
pends on the available treatments in each location. It is essential to
inform users by labeling and sorting instructions, along with awareness
campaigns to increase participation in source segregation, and com­
bined it with efficient management policies, such as the extended pro­
ducer responsibility, to improve the environmental performance of
pharmaceutical packaging.
Declaration of competing interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Data availability
The data that has been used is confidential.
Acknowledgements
The authors gratefully acknowledge the support of Valormed (Inte­
grated waste management system of pharmaceutical packaging waste in
F. Bassani et al.
Portugal), in particular Luis Figueiredo for his contributions. This
research has also been supported by projects SET-LCA (CENTRO-
01–0145-FEDER-030570) co-funded by European Regional Develop­
ment Fund (ERDF) through POCentro (PT2020) and Fundação para a
Ciência e Tecnologia, Portugal (FCT), and S4Plast (POCI- 01–0247-
FEDER-046089) funded by FEDER through Compete2020 (Operational
Program Competitiveness and Internationalization). We are also
thankful to the anonymous reviewers for valuable suggestions e detailed
comments.
Appendix A. Supplementary material
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.wasman.2023.12.022.
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