Comparison of reusable and single-use specula in Belgian hospitals: an environmental life cycle assessment and economic analysis

Awareness is growing about the need for a circular healthcare sector. Choosing between single-use (SU) and reusable (RU) medical instruments should be based on evidence-based reasoning. RU and SU instruments differ in many stages of their life cycle. Vaginal specula are commonly used instruments in hospitals and in primary care. The aim of this study was to compare the environmental and economic cost of RU specula and three types of SU specula.

This study evaluated the environmental sustainability of using RU or SU vaginal specula through a cradle-to-grave life cycle assessment (LCA), using the ReCiPe 2016 Midpoint (H) V1.07 method, including 18 midpoints and the three endpoints human health, ecosystem quality, and resource scarcity. One pelvic examination was the functional unit to compare RU stainless steel specula with SU specula made of (i) fossil-based acrylonitrile butadiene styrene (SU ABS), (ii) bio-based polylactic acid (SU PLA), or (iii) polystyrene blades and a polyethylene bolt sterilised with ethylene oxide (SU EO). Alongside the LCA, an economic evaluation was conducted based on the total cost of ownership (TCO). Scenario analyses were performed for the environmental and economic part of the study.

RU specula scored best for global warming leading to 86% less impact than SU ABS, 78% less than SU PLA specula, and 84% less than SU EO specula in the baseline scenario. RU specula performed better than SU specula from four to seven reuses, depending on the SU type. For the three endpoint estimates, RU specula were most favourable in the baseline scenario. Cost analysis for RU specula resulted in a total cost between € 1.22 and € 1.38 per use and between € 0.75 and € 1.34 per use for SU specula. Labour costs comprised more than half of the overall expenses for RU specula, whereas acquisition cost the main cost driver was for SU specula.

Environmental and economic hotspots of RU and SU specula were identified and can be used in decision-making about using more RU instruments. Raw materials and manufacturing were the key environmental and economic impact factors of SU specula. Packaging production and waste management were the main drivers of the environmental impact of RU specula but had only a minor economic impact on the TCO.