Where the Real Circular Economy Opportunities Are for MedTech Start-ups (Including MDSW Founders)

Over the last two posts, I explained what the circular economy and the 9R system are, and why they’re worth your limited time. In this post, I’ll show you where the real opportunities lie, mapped to different business models - including if you’re building medical device software (MDSW) rather than hardware.

R0–R1 Refuse / Rethink - software is often the common thread. In fact, some of the most overlooked circular economy opportunities are driven by software in two ways.

The first substitution: telemedicine, remote monitoring and digital diagnostics dematerialise care by replacing physical appointments or devices with data.

The second is through new delivery models. Device-as-a-service and shared-equipment platforms enable healthcare providers to make better use of expensive equipment instead of each purchasing their own, and these platforms are typically software-based.

Both approaches can generate recurring revenue wile reducing the GHG footprint per patient treated. If you’re building medical device software (MDSW), it’s easy to assume that circularity is a hardware challenge. In reality, you may already be applying one of the most powerful circular strategies without even calling it that.

R2 Reduce - design, materials and packaging. Start-ups developing devices made from more sustainable materials, such as bio-based plastics, or reducing packaging, are tackling waste at its source. Designing out unnecessary material from the outset is an attractive opportunity, particularly as EU eco-design and packaging requirements continue to tighten.

The benefits are twofold: lower manufacturing and packaging costs today, and a stronger competitive position as future acquirers increasingly scrutinise sustainability performance.

R3–R5 Reuse, Repair, Refurbish. This is where a device is kept in use for a different patient after being validated as safe, rather than being discarded after a single use. Examples include rental models for diagnostic or monitoring equipment, or devices that are validated for a defined number of safe reuses. The same principle applies to larger capital equipment in hospitals, which is routinely serviced and maintained throughout its lifetime. Refurbishing equipment instead of replacing it outright is often the most economical solution for manufacturers, healthcare providers and patients alike.

R6 Remanufacture - the most heavily regulated field. Around one-third of EU countries currently permit the remanufacturing of certain single-use medical devices (Switzerland is not among them) [9], and established companies are already active in this field. The proven model: collect eligible used single-use devices, remanufacture them to the original manufacturer’s specifications under an MDR-compliant quality management system, and re-sell them back to the hospitals for reuse. This approach already is successfully in place for many of the more expensive single-use devices.

R7 Repurpose - the enabling infrastructure. Components recovered from decommissioned devices such as motors, optics, batteries and sensors, can be repurposed for lower-risk applications. While this is a smaller market than remanufacturing, it is generally less capital-intensive and subject to a lighter regulatory burden.  

R8 Recycle and R9 Recover - particularly relevant for critical raw materials. Opportunities include reverse logistics, namely take-back schemes, decontamination before recycling, and separating mixed plastics and metals found in clinical waste. Unglamorous, infrastructure-heavy, and precisely why it remains underdeveloped. Increasingly, waste-management companies are using AI-assisted sorting technologies to improve recovery rates and make this business model more commercially viable.

To summarise, the table below revisits the 9R framework introduced in Part 1 and further illustrates concrete MedTech applications:

R	Strategy	Description	Potential MedTech Solution
R0	Refuse	Make product redundant by abandoning its function or by offering the same function with a radically different product	Software products that remove the need for a new physical device (e.g. telemedicine, remote monitoring, digital diagnostics).
R1	Rethink	Make product use more intensive (e.g. by sharing product)	Device-as-a-service / shared capital equipment models.
R2	Reduce	Increase efficiency in product manufacture or use by consuming fewer natural resources and materials	Bio-based plastics, mono-material or reduced packaging, eco-designed devices.
R3	Reuse	Reuse by another consumer of discarded product which is still in good condition and fulfils its original function	Reprocessed or rental devices reused by different patients after validated cleaning (e.g., rental of diagnostic or monitoring equipment).
R4	Repair	Repair and maintenance of defective product so it can be used with its original function	Repair of capital equipment (imaging, surgical robots) and reusable surgical instruments.
R5	Refurbish	Restore an old product and bring it up to date	Refurbishment of capital equipment and devices sold as “device-as-a-service” to extend their working life.
R6	Re-manufacture	Use parts of discarded product in a new product with the same function	Remanufacturing of expensive single-use devices (e.g., catheters, surgical tools) to original spec under an MDR-compliant QMS.
R7	Repurpose	Use discarded product or its parts in a new product with a different function	Components from decommissioned devices (motors, optics, batteries, sensors) reused in other lower risk markets.
R8	Recycle	Process materials to obtain the same (high grade) or lower (low grade) quality	Take-back schemes, decontamination, and sorting infrastructure for mixed plastics and metals in clinical waste.
R9	Recover	Incineration of material with energy recovery	Recovery of critical raw materials (metals, rare earths) and energy from end-of-life devices.

That’s the series. From what circular economy actually is, to why it’s worth your limited time, to where the real opportunities lie. If you’ve read all three, you’re probably further along your circular economy journey than you think.

I'm currently building a map of circular MedTech start-ups. If you’re working on something in this space, send me a one-line description of what you're building. I'll suggest which of the 9R strategies are most relevant to your business and where I'd focus first. And if you'd like, I'll add your company to the map too.

References

[9] Valdivia S, Specker A, Anta M. “Are EU Regulations Ready to Allow Circularity in Digital Healthcare Devices?” Digital Health in the Circular Economy (DiCE), 27 June 2024. https://circulardigitalhealth.eu/news/1524-eu-regulations-directives/.

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Regulatory Affairs and Circular Economy - explained in plain English.

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