Availability, accessibility, and economic feasibility of radionuclide therapies in Africa: a systematic review and quantitative infrastructure analysis.

PURPOSE: Africa faces a projected doubling of cancer burden by 2040, yet access to radionuclide therapies remains critically limited. This systematic review quantifies the availability, accessibility, and economic feasibility of therapeutic nuclear medicine across 54 African nations.

METHODS

This study combined a PRISMA 2020-compliant systematic literature review with secondary database analysis. A comprehensive search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and African Journals Online (January 2022-March 2026). Epidemiologic and infrastructure data were additionally obtained from GLOBOCAN 2022 and the International Atomic Energy Agency (IAEA). Risk of bias was assessed using the modified Newcastle-Ottawa Scale for peer-reviewed studies and the AACODS checklist for gray literature.

RESULTS

Of 2,847 records identified, 47 studies met the inclusion criteria. I-131 therapy for thyroid cancer is available in only 28/54 countries (51.9%), while Lu-177-PSMA for prostate cancer is available in only seven countries (13.0%). Local radiopharmaceutical production reduces therapy costs by 93%-96% compared with imported agents. Africa has approximately 0.18 nuclear medicine physicians per million population vs. 3.1 in Europe. The cost reduction ratio for local vs. imported Lu-177-PSMA is 1:28.3 (US$1,500-3,000 vs. US$42,500).

CONCLUSION

Radionuclide therapy availability in Africa is profoundly inadequate relative to disease burden. Economic modeling demonstrates that local production and regional hub models can achieve cost reductions exceeding 90%, making therapies economically feasible for resource-limited settings. Targeted investment in cyclotron infrastructure and workforce development is urgently needed.