Shifts in Urbanicity-Based Access to Radiotracers for Neuroendocrine Tumors

To investigate the effect of newer radiotracers-⁶⁸Ga-DOTATATE/DOTATOC and ⁶⁴Cu-DOTATATE-compared with ¹¹¹In-pentetreotide on geographic access to radiotracers for patients with neuroendocrine tumors (NETs).

This retrospective study (2014-2023) used claims from a 5% sample of Medicare fee-for-service beneficiaries. Claims for ¹¹¹In-pentetreotide (Octreoscan, Curium US LLC, Boston, MA), ⁶⁸Ga-DOTATATE/DOTATOC (gallium), and ⁶⁴Cu-DOTATATE (copper) were extracted for all beneficiaries with NET. Distance traveled was based on the patient and facility ZIP codes. All claims for ¹⁸F-fluorodeoxyglucose were used as a proxy for PET/CT access. Distances traveled were compared across radiotracers, urbanicity, and time periods.

There were 245,775 claims that met selection criteria. Gallium's initial market share was 33.8% in 2017 and peaked at 90.9% in 2020. Copper's initial market share was 21.0% in 2021 and increased to 40.6% in 2023, with greater penetration among patients from small or rural areas. When gallium was the only PET-based NET radiotracer (2017-2020), patients from small or rural areas traveled 134.9 miles further for gallium versus Octreoscan (P = .001). One-third of this difference can be explained by differences in access to PET/CT, as the incremental distance traveled by patients from small or rural areas for ¹⁸F-fluorodeoxyglucose over Octreoscan was 43.7 miles. After copper was introduced (2021-2023), the metropolitan or micropolitan--small or rural difference closed and was mostly indistinguishable from the effect of the distribution of PET capabilities.

Octreoscan utilization expectedly declined with the introduction of PET-based radiotracers, likely due to their clinical superiority, with greater penetration of copper in small or rural areas. Copper reduced distance traveled by patients with NETs given its comparable diagnostic accuracy and greater geographical availability compared with gallium.