Science and technology

The Supply of Medical Isotopes

An Economic Diagnosis and Possible Solutions

Published on November 18, 2019

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.


Abbreviations and acronyms
Executive summary
Key findings
Health care systems require Tc‑99m to maintain patient care
The use of nuclear medicine diagnostics and Tc-99m varies significantly across countries
Health care providers have varying incentives to contain the cost of Tc-99m
The Tc-99m supply chain is technically complex and characterised by market imperfections
Barriers to Full-Cost Recovery and Policy Options
Annexes4 chapters available
Broader responses to the 2009/10 Mo-99/Tc-99m shortage
NM Diagnostic activity by country – Data sources and comparability
OECD Health Division Survey on Health Care Provider Payment for Nuclear Medicine Diagnostic Services
Current unbundled Tc-99m payments in Germany and Japan
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The Supply of Medical Radioisotopes: An Economic Diagnosis and Possible Solutions
18 November 2019
14:30-16:00 Paris time

The Nuclear Energy Agency (NEA) will host a webinar on 18 November 2019 to present findings from a new report on the supply of medical radioisotopes, jointly produced with the Organisation for Economic Co-operation and Development (OECD) Health Committee.

Join William D. Magwood, IV, Director General of the NEA, Mark Pearson, Deputy Director of Employment, Labour and Social Affairs at the OECD, Jan Horst Keppler, Senior Economist at the NEA, and Martin Wenzl, Health Policy Analyst at the OECD, to hear the key findings of this new joint report.

Interested professionals, journalists and members of the public who would like to be able to submit questions before or during the webinar can send them via Twitter @OECD_NEA or e-mail to

The webinar is available on the OECD Web TV:



  • Millions of patients benefit from diagnostic services made possible by advances in medical imaging. The medical radioisotopes that make these procedures possible are supplied by an ageing nuclear infrastructure.
  • The most widely used medical radioisotopes, molybdenum-99 (99Mo) and technetium-99m (99mTc), have to be produced daily. Any supply chain disruption can delay or cancel important medical procedures, with consequences for patients, their treatment and their health.
  • Ageing production facilities and low prices for Technetium-99m, one of the most widely used medical radioisotopes, has made its supply unreliable. Only 10 nuclear reactors, many of which are nearing 50 years of operation, produce over 95% of the world’s supply.
  • Production of Technetium-99m, one of the most widely used medical radioisotopes, is not fully economically viable at current prices; its supply chain structure prevents producers from charging prices that reflect its full costs.



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