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.
Foreword
Technetium-99m (Tc-99m) is the most commonly used radioisotope in nuclear medicine (NM) diagnostic scans. It is essential for diagnostic scans of a broad range of body parts, and thus for accurate diagnoses of diseases, such as cancer, heart disease and neurological disorders including dementia and movement disorders, and effective patient care in health systems of OECD countries. It is also the most common diagnostic radioisotope, estimated to be used in approximately 85% of all NM diagnostic scans worldwide. The properties of Tc-99m, however, make its supply chain complicated. Tc‑99m is obtained from radioactive decay of its parent isotope, Molybdenum‑99 (Mo‑99). Neither of these products can be stored for very long. Mo‑99 has a half‑life of 66 hours, that is, its radioactivity decreases by half in 66 hours, and the half-life of Tc‑99m is only six hours. Therefore, supply is a just-in-time activity, combining a mix of governmental and commercial entities, and requires sufficient capacity for ongoing production of Mo‑99 plus a reserve in case of unplanned outages.