Evaluating pharmaceutical reverse logistics sustainability with a Pythagorean fuzzy multi-criteria approach

Introduction – Pharmaceutical reverse logistics is essential for safe medicine take-back, regulatory compliance, and sustainability. However, selecting an appropriate reverse logistics model requires evaluating conflicting criteria under uncertainty. Methods – This study proposes a two-stage Pythagorean fuzzy decision framework integrating PF-ITARA and PF-EDAS. Eighteen criteria were grouped into six sustainability clusters: economic, environmental, regulatory, operational, accessibility, and infrastructural. PF-ITARA was used to calculate criterion weights, and PF-EDAS was applied to rank four alternatives: third-party take-back, manufacturer-led returns, pharmacy-led collection, and government recycling centers. Results – Processing/transportation cost was the most influential criterion, with a weight of 0.1264, followed by carbon footprint (0.0818) and storage cost (0.0809). Government recycling centers achieved the highest assessment score (0.507), followed by third-party take-back (0.496), pharmacy-led collection (0.491), and manufacturer-led returns (0.484). The maximum score difference among alternatives was 0.023, indicating close competition but a stable preference pattern. Discussion – The proposed framework provides an auditable and threshold-sensitive tool for pharmaceutical reverse logistics decisions. The findings suggest that public recycling infrastructure may offer a more balanced option across cost, safety, environmental, and accessibility requirements, while also clarifying key cost–sustainability trade-offs for policymakers, manufacturers, and healthcare organizations.