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CHAPTER 3. COST IMPACTS OF LEU-TARGET CONVERSION 99Mo production continues to be subsidised in some facilities, not only will long-term supply security be threatened from the unsustainable economic situation, it will also be threatened by hindering the LEU-target conversion process. Cost impacts on patients resulting from LEU-target conversion It is important to understand the impact of the expected cost increases on the end payer, as they are the ones that will see the final impact. Drawing from the data from the economic study,3 the modelling applied the cost impacts upstream to determine the expected impacts on the 99mTc used in the patient procedure. From the global data and based on a weighted average of 99mTc-based procedures, NEA based its assessment on the following starting values: • cost of a dose of 99mTc from the radiopharmacy per imaging procedure: EUR 10.86; • reimbursement rate for the imaging procedure: EUR 245. It is important to remind the reader that these values are only meant to be indicative as there could be a large range depending on the medical procedure and the jurisdiction. The prices used were normalised to 99Mo 6-day curies in order to facilitate the comparison across the supply chain.4 Table 3.7 presents the results of applying the cost impacts from LEU-target conversion on the price of the 99mTc dose from the radiopharmacy or hospital nuclear medicine department. Applying the cost increases upstream to the end user, the modelling shows that the price of the procedure dose of 99mTc from the radiopharmacy is expected to increase less than EUR 1, from the full-cost reference case value of EUR 10.94 to EUR 11.79 under the worst case cost impact scenario. Within a reimbursement rate of EUR 245, this translates to the 99mTc dose increasing its share from 4.46% up to 4.8% (see Table 3.8). While this increase of less than EUR 1 on EUR 245 to pay for the costs of LEU-target conversion is a very small increase, it is important to realise that this increase must be paid for and the payment must flow upstream to support the necessary changes. Table 3.7. Cost impact of LEU-target conversion of the 99mTc dose Impact scenario Reference case without FCR Reference case with FCR High infrastructure Low infrastructure Full range Value from each supply chain segment (in EUR) within the cost of the 99mTc radiopharmacy dose (cumulative for each stage of the supply chain)1 Irradiator Processor Generator manufacturer 0.26 1.90 2.24 0.35 1.99 2.33 0.41 2.40 2.74 0.44 2.51 2.84 0.36-0.48 2.11-2.84 2.45-3.18 Radiopharmacy/nuclear medicine department 10.86 10.94 11.35 11.46 11.07-11.79 1. Values are meant to be illustrative of the situation and should not be construed as being the absolute true value in the market. 3. While there were concerns presented about the radiopharmacy and end-payer data in the economic study, especially related to fact that there is little US data included, additional data were not provided to the NEA despite numerous attempts to obtain the data. As a result, the NEA undertook the LEU-target conversion assessment with the data it had. 4. For a full discussion of the methodology to normalise the prices of 99mTc to 6-day curies of 99Mo, refer to Annex 2 of OECD/NEA, 2010. MARKET IMPACTS OF CONVERTING TO LOW-ENRICHED URANIUM TARGETS FOR MEDICAL ISOTOPE PRODUCTION, ISBN 978-92-64-99197-2, © OECD 2012 47PDF Image | Market Impacts of Converting to Low-enriched Uranium Targets for Medical Isotope Production
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