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.

Published on November 18, 2019


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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