The Supply of Medical Isotopes
An Economic Diagnosis and Possible Solutions
This report explores the main reasons behind the unreliable supply of Technetium-99m (Tc-99m) in health-care systems and policy options to address the issue. Tc-99m is used in 85% of nuclear medicine diagnostic scans performed worldwide – around 30 million patient examinations every year. These scans allow diagnoses of diseases in many parts of the human body, including the skeleton, heart and circulatory system, and the brain. Medical isotopes are subject to radioactive decay and have to be delivered just-in-time through a complex supply chain. However, ageing production facilities and a lack of investment have made the supply of Tc-99m unreliable. This report analyses the use and substitutability of Tc-99m in health care, health-care provider payment mechanisms for scans, and the structure of the supply chain. It concludes that the main reasons for unreliable supply are that production is not economically viable and that the structure of the supply chain prevents producers from charging prices that reflect the full costs of production and supply.
Health care systems require Tc‑99m to maintain patient care
Nuclear medicine diagnostic procedures support diagnoses of disease in a broad range of medical specialties, organ systems and clinical indications. Prior experience illustrates that substitutes are available for some Technetium-99m-based scans. Cardiac and bone scans, which are a large share of all diagnostic scans, are notable examples of where substitution is possible. In some areas, alternatives to Tc-99m, such as PET scans in myocardial perfusion imaging, may in fact offer improved diagnostic performance. However, even where substitution is possible from a clinical point of view, it might not be easy to achieve in practice. For example, the current base of PET, CT and MRI equipment and workforce may not be able to absorb the additional volume of scans necessary to substitute for the use of Tc-99m. Substitution may also imply cost increases for health systems. No comparable substitutes are available in indications such as breast, melanoma and head/neck cancer sentinel lymph node studies, and in a range of diagnostics in children. In some areas Tc-99m-based scans also continue to be the preferred standard of care, such as whole-body bone scans to screen for skeletal metastases. Tc-99m will therefore continue to be an essential product for health systems.
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