Abstract
Background
One of health inequalities’ major cause is bad accessibility to healthcare services. We focus on nuclear medicine (NM) examinations, which take place via SPECT and PET scanners, both using radiopharmaceuticals which can prove to be expensive and weather dependent to deliver in island regions. Their production requires expensive to install and run equipment, but a recent project has shed light on a 1970s idea: hybrid used cyclotrons (HC), capable of producing radiopharmaceutical types for both camera types.
Methods
Many factors need to be considered when conducting cost-minimization analyses (CMA) for public health purposes in island regions: once we decide on the opportunity to install a cyclotron, we need to choose the cyclotron type being the most suitable for the specific need. We perform an economic evaluation of these scenarios for Corsica, Sardinia, Crete and Cyprus using CMA for a period of 20 years, starting in 2025.
Results
We show that the least costly solution is transport of all radiopharmaceuticals from the mainland for low, normal cyclotron for intermediate and hybrid used cyclotron for sufficiently high number of annual PET examinations. Total costs are quite similar for HC and normal cyclotrons, with HC being the least costly solution for all four islands. The number of years after which either type of cyclotron becomes cost minimizing depends on the total number of PET, rather than SPECT, examinations and varies from <1 to 17 years. Our research shows that if the initial annual number of PET examinations is at least equal to 0.2% of the total population, then cyclotron installation is the most cost minimizing solution.
Conclusions
Radiopharmaceutical production represents an important outcome, since it affects the accessibility to NM services for isolated regions, like islands. Enhancing accessibility to these healthcare services represents a lever for reducing healthcare inequalities for diseases such as cancer. This analysis can be adapted to other island regions, such as Canary Islands, New-Caledonia, etc., but also remote mainland locations. For remote places with expected annual number of PET examinations at least equal to 0.2% of the population, local radiopharmaceutical production is the least costly solution.