UQ study finds funding gaps hinder access to theranostic cancer care

UQ study finds funding gaps hinder access to theranostic cancer care

Health systems are struggling to accurately assess the cost-effectiveness of theranostic nuclear medicine, a struggle that is stalling patient access to a personalized frontier of cancer treatment, according to a University of Queensland study.

The research team, led by Professor Haitham Tuffaha and health economist Dr Yufan Wang, reviewed the value for money of theranostics. This approach integrates diagnostic imaging with targeted radiopharmaceutical therapy, allowing clinicians to treat what they see, Dr Wang said. The method delivers radiation directly to cancer cells while sparing healthy tissue, typically resulting in mild side effects for the patient.

Despite the clinical potential, Dr Wang noted that the treatment is expensive due to workforce capacity, manufacturing capability, regulatory approvals, production costs, and radionuclide supply. This has left global health systems questioning if the treatments are worth the cost.

Funding Model Inconsistencies

The team analyzed 25 economic evaluations of theranostic radiopharmaceuticals used globally. Their findings suggest that conventional healthcare funding models are not well suited for these advanced treatments. Dr Wang observed that almost no economic evaluations assessed the therapeutic and diagnostic components together as a genuine theranostic pair, despite such integration being the purpose of the technology.

The study also revealed significant disparities in how the value of the treatment is calculated. Costs per year of healthy life gained ranged from USD$21,000 to $400,000. Because of variations in model structures, costing perspectives and health outcome measures, comparisons between evaluations were described as almost impossible.

Professor Tuffaha stated that the lack of an appropriate funding framework has real-life consequences, noting that it can limit or delay patient access to treatment. He described a dedicated reimbursement pathway that recognizes the unique value of theranostic nuclear medicine as an urgent clinical necessity.

Broadening the Access Gap

The University of Queensland study highlights a broader challenge in oncology where systemic barriers hinder high-quality care. While the UQ team focuses on the financial frameworks of nuclear medicine, other institutions are targeting the logistical barriers to entry.

The Duke Cancer Institute (DCI) and UCSF Helen Diller Family Comprehensive Cancer Center have implemented models to accelerate care. DCI launched an "E-Comm" pathway in 2021, using oncology advanced practice providers (APPs) to review e-consults for patients with suspected malignancies. Between August 2023 and August 2024, DCI completed 900 such consults.

The Role of Technology and AI

Technological integration is becoming central to precision oncology. Artificial Intelligence (AI) is being used to standardize treatment and reduce variability in radiation therapy workflows. Deep learning (DL) techniques can synthesize diverse data types—including image and omic data—that often exceed the cognitive capacity of a single oncologist.

AI applications currently being investigated include:

• Diagnosis and Screening: Tools like Mirai for mammograms and Sybil for lung cancer risk prediction.
• Pathology: Algorithms such as DeepPATH for distinguishing lung cancer types.
• Treatment Planning: AI used for tumor-organ segmentation and creating synthetic CT images from MRI data to avoid additional radiation exposure.

Beyond clinical settings, digital health platforms are attempting to expand access. Meanwhile, the President’s Cancer Panel submitted a report to the White House in 2024 recommending the use of technology to enhance patient navigation and health equity, provided such tools augment rather than replace human interaction.

The UQ research team is now moving toward the next stage of their work: the development of a value framework intended to guide future reimbursement decisions for theranostics.