As precision oncology increasingly captures headlines, a quieter revolution in cancer treatment is raising an urgent question that clinicians and payers alike cannot ignore: does pairing radiopharmaceutical imaging with targeted radioactive therapy actually justify its steep price tag? The answer, for now, remains stubbornly incomplete — and that matters enormously for patients who may soon face access barriers based on economic modeling that is still immature.
This systematic review, spanning 25 published studies and health technology assessments from 2015 to 2025, examined the cost-effectiveness landscape of radiotheranostic therapy (RTT) — an approach that uses radioactive compounds both to identify and then destroy cancer cells. The analysis drew from 16 articles or reports plus 9 formal health technology appraisals, covering 25 studies across seven major databases and multiple national HTA agencies. The dominant radiopharmaceuticals under economic scrutiny were gallium-68 (Ga-68) for imaging, evaluated in 80% of imaging studies, and lutetium-177 (Lu-177) for therapeutic delivery, which appeared in all radiopharmaceutical therapy evaluations. Prostate cancer and neuroendocrine tumors together accounted for the full spectrum of modeled disease contexts.
What this review exposes is a field where clinical excitement has substantially outpaced economic rigor. Lutetium-177-based therapies — including the FDA-approved Lu-177 DOTATATE and Lu-177 PSMA-617 — carry list prices that can exceed $100,000 per treatment course, making robust cost-effectiveness modeling not merely academic but a gatekeeping function for millions of patients. The methodological heterogeneity identified here is a genuine concern: when economic models diverge in structure, comparators, and time horizons, their conclusions become difficult to synthesize or trust at the policy level. For health-conscious adults navigating cancer care, this finding serves as a practical caution — the coverage decisions that govern access to these therapies rest on economic evidence that is, by this review's own assessment, methodologically inconsistent. This is an incremental but important contribution that should accelerate demand for standardized modeling frameworks before RTT becomes further embedded in oncology guidelines.