Patient access to one of the most exciting frontiers in cancer treatment is being stalled because health systems struggle to accurately assess its cost-effectiveness, a University of Queensland study has found.
A team led by health economists Dr Yufan Wang and Professor Haitham Tuffaha set out to review the value for money of theranostic nuclear medicine, which combines diagnostic imaging and targeted radiopharmaceutical therapy in a precise, personalised approach to cancer care.
“Theranostics is considered a game changer in cancer management, particularly in cases where the disease has spread, because it allows clinicians to ‘treat what they see’,” Dr Wang said.
“Radiation can be delivered directly to cancer cells, sparing healthy tissue, with usually mild side effects for the patient.
“But it is expensive considering radionuclide supply, production costs, manufacturing capability, regulatory approvals and workforce capacity.
“Health systems around the world are weighing up whether to fund these treatments, so the critical question is: are they actually worth the cost?”
Dr Wang said the team analysed 25 economic evaluations of theranostic radiopharmaceuticals in use globally.
“We found conventional healthcare funding models were clearly not well suited to these advanced treatments,” she said.
“Almost no economic evaluations assessed the diagnostic and therapeutic components together as a genuine theranostic pair – even though that integration is the whole point of this technology.
“There were also many inconsistencies in the calculations of cost per year of healthy life gained from theranostics, ranging from USD$21,000 to $400,000.
“Variations in health outcome measures, costing perspectives and model structures made comparisons almost impossible.”
Professor Tuffaha said there were real life consequences to a lack of an appropriate funding framework.
“Patient access is affected which can delay or limit access to this treatment,” Professor Tuffaha said.
“A dedicated reimbursement pathway that recognises the unique value of theranostic nuclear medicine for cancer patients is an urgent clinical necessity.
“There is a sector-wide effort calling for action.
“The next stage of our research is to develop a value framework to guide reimbursement decisions.”
Read the systematic review in the Journal of Nuclear Medicine.
Collaboration and acknowledgements
The review was funded and run through AMTAR (ARC Hub for Advanced Manufacture of Targeted Radiopharmaceuticals) with researchers from UQ’s Centre for the Business and Economics of Health and Australian Institute for Bioengineering and Nanotechnology .
