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.
The use of nuclear medicine diagnostics and Tc-99m varies significantly across countries
Diagnostic imaging modalities using Technetium-99m account for around 30 million examinations worldwide every year and approximately 85% of all nuclear medicine diagnostic scans. Following a decrease with the 2009/10 supply crisis, demand for Tc-99m has been flat in recent years and little growth is forecast for OECD countries through 2023. Imaging rates vary significantly between countries, from 2‑3 Tc-99m-based scans per 1 000 population per year in some Eastern European countries to 30‑50 in Belgium and North America. The ten most populous countries and countries with high scan rates account for more than 90% of the aggregate volume of Tc-99m-based scans across the countries in scope of this Report. There are also significant differences between countries in the utilisation patterns by organ system and anatomical areas scanned. The potential impacts of future shortages and the scope for substitution are therefore not the same across countries.
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