Cost-effectiveness of routine radiochemical quality assurance testing of technetium Tc 99m radiopharmaceuticals

The cost-effectiveness of performing routine radiochemical quality assurance (QA) testing of technetium Tc 99m radiopharmaceuticals was evaluated. Data were collected retrospectively on use and failures of radiopharmaceuticals over a 30-month period at a university hospital. Cost of quality assurance testing of the radiopharmaceuticals and cost of not performing this routine testing (e.g., repetition of invalid studies) were compared. Possible reasons for failure of radiopharmaceuticals to meet QA standards were examined. Based on these data and an informal survey of the incidence of failures at other nuclear pharmacies, expected radiopharmaceutical failure rates were calculated. The incidence of failures at the study institution was 0.56% (20 of 3775); the other nuclear pharmacies reported similar data. Based on these data, 6 failures per 1000 technetium Tc 99m radiopharmaceuticals prepared were predicted. "Low tin" kits (e.g., albumin aggregated) with low-specific-activity sodium pertechnetate Tc 99m were associated with failure to meet QA standards. Direct costs of QA testing were slightly less than direct costs associated with not testing; however, consideration of indirect costs confirmed the cost-effectiveness of QA testing. Routine radiochemical QA testing of technetium Tc 99m radiopharmaceuticals appears to be cost-effective.