Publicatie Laka-bibliotheek:
The Supply of Medical Isotopes. An Economic Diagnosis and Possible Solutions


Uit de publicatie:

The Supply of Medical Isotopes

OECD NEA, 2019

Executive summary
This report explores the use and substitutability of Technetium-99m (Tc-99m) 
in health care and the main economic reasons behind its unreliable supply. 
It proposes policy options to help address the supply issue. Tc-99m is an 
essential product for health systems that is used in 85% of nuclear medicine 
diagnostic scans performed worldwide, or around 30 million patient 
examinations every year, making it the most commonly used medical isotope. 
Tc-99m-based scans allow diagnoses of a broad range of diseases in many parts
of the human body, including cancer, heart disease and neurological disorders 
such as dementia.
Substitution of Tc-99m is difficult. No comparable substitutes are available 
for diagnoses of various cancers, such breast, melanoma and head/neck cancer, 
and for a range of diagnostics in children, in particular paediatric bone and 
renal scans. In some areas, Tc-99m-based scans are the preferred standard of 
care, such as whole-body bone scans to screen for skeletal metastases. Although 
substitution of Tc-99m is clinically possible for some of the most common types 
of diagnostic scans, notably cardiac and bone scans, effective substitution of 
these would imply cost increases and require significant long-term investments 
in alternative scanning equipment and human resources.
Medical isotopes are subject to radioactive decay and cannot be stored. For this 
reason, they have to be delivered just-in-time through a complex supply chain 
that requires sufficient capacity for ongoing production, plus a reserve in case 
of unplanned outages. However, ageing production facilities and low prices of 
Tc-99m have contributed to a lack of production capacity, which has made the 
supply of Tc-99m unreliable. The current structure of the supply chain leaves 
some participants unable to increase the prices of their services to levels 
that would cover all fixed and variable costs of the required production 
capacity for Tc-99m.