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A new Integrated Performance Management Model to improve the Supply Chain of Radiopharmaceutical products: development and application to the case of Tc-99m

par Rabarijaona, Haingo
Président du jury Hendrick, Patrick
Promoteur Ndiaye, Alassane Ballé
Publication Non publié, 2023-10-24

Thèse de doctorat

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Résumé :

BACKGROUND The diagnosis of numerous diseases such as cancer, bone disease, thyroid complications, as well as heart conditions and pulmonary diseases (among the main diseases causing death according to WHO, 2020), requires an imaging procedure that is supported by Technetium 99m (Tc-99m). It is a radionuclide that, for medical usage falls into the category of radiopharmaceuticals. In nuclear medicine, a radiopharmaceutical is a product composed of a small amount of radioactivity for the diagnosis and treatment of various diseases (MEDraysinstell, 2017). Dedicated to diagnosis purposes, the Technetium-99m (Tc-99m) is a decay product of Molybdenum-99 (Mo-99), and is one of the most widely needed radionuclides, supporting 80% of in-vivo diagnosis procedures. This percentage corresponds to more than 30 million examinations worldwide each year (World Nuclear Association, 2019). The nature of the product itself, which is time sensitive and cannot be stored due to its physical and chemical characteristics which decays over time, yields a substantial layer of complexity in the management of its supply chain, from production to usage and discharge.As pharmaceutical products and dangerous goods, they are subject to strict regulations. Moreover, the financial and market structure of the industry complexifies the Tc-99m supply chain (OECD/NEA, 2010). Notwithstanding few collaborations between actors (such as shared capacity models), the management of the supply chain of this life-saving product is more silo-based and fragmented than truly integrated as must be a real supply chain ecosystem.Furthermore, the radiopharmaceutical supply chain is composed of only a handful stakeholders that are providing a growing international market, with a projected increase of over 18% by 2028 (MEDraysinstell, 2023).Supply Chain Management Science teaches that to reach highest values of performance and build a strong overall competitive performance, the actors all along the chain must be integrated through a systemic approach that perceives the supply chain as a “single entity”, rather than as a set of fragmented parts (Houlihan, 1985; A. Ndiaye et al., 2019). This approach expands the notion of partnerships into a collaborative endeavor that encompasses multiple firms (Ellram & Cooper, 1990b) to improve the long-term performance of the individual companies and the overall performance of the entire supply chain ecosystem (Mentzer et al., 2001, A. Ndiaye et al., 2019). This approach highlights the fundamental need to have supporting advanced tools that can model, evaluate, and monitor the journey towards integration, towards the highest levels of overall performance. Such tools can significantly enhance the decision-making process, fostering a more proactive and effective change approach (A. Ndiaye et al., 2019). RESEARCH QUESTION How can such an advanced tool be developed and applied to the Mo-99/Tc99m case, to support the setting of a truly integrated supply chain ecosystem and improving the decision-making process?METHODOLOGICAL APPROACH FOR THE DESIGN OF THE TOOL To support and drive the journey towards an integrated supply chain ecosystem, a Supply Chain Performance Management System (SCPMS) is needed. Maestrini et al. (2017) defined a SCPMS as a "set of [select] metrics used to quantify the effectiveness and efficiency of supply chain [operations], processes and relationships, spanning multiple organisational functions, [stakeholders,] and companies, and enabling the orchestration of the supply chain”. To be effective, this decision-making tool must be tailor-made for a given industry, and specifically designed to capture the different characteristics of the product(s), the stakeholders, the relationships along the chain, the ranges of operations and processes, the dynamics of the ecosystem. This includes considerations such as the regulations, the financial and institutional factors, the behaviour of competitors, the market specificities and its dynamics, the technological and digital trends, the societal trends, the environmental trends, and more (Ndiaye, 2019, lecture notes).The design of such a tool for the Tc-99m/Mo-99 supply chain involved the careful definition of select metrics according to five strategic axes of the supply chain which were identified in the diagnosis phase through interviews, field observations, investigations, and literature review: operational, regulatory, social, environmental, and financial. A particular stage of the design process dealt with the aggregation of 50+ performance indicators according to their nature with the use of both simple and multi-criteria aggregation methodologies. Another stage of the design process relates to the generation of decision-making scenarios to improve performance. Once the tool is applied and identifies the underperforming elements of the supply chain, the stakeholders are gathered to generate realistic solutions. The impacts of these solutions on the entire supply chain ecosystem are evaluated. Based on this evaluation, decision-making scenarios are designed, then compared and ranked with the Promethée II method, a pairwise comparison method (Brans & Mareschal, 2005). The scenario yielding the maximum overall performance value is then highlighted as the one which, once applied, will ensure the highest overall performance of the supply chain. The five-step design process resulted in an advanced tool able to model, evaluate, and monitor the journey towards integration, towards the highest levels of overall performance of the Tc-99m/Mo-99 supply chain: an overall performance management model, named IRSCP: Integrated Radiopharmaceutical Supply Chain Performance Management Model.RESULTS AND PERSPECTIVESThe IRSCP was pilot applied and validated through a case study involving actors of the Tc-99m supply chain. The initial results of the analysis showed promising decision-making scenarios through which the overall performance of the supply chain of Tc-99m can be improved, triggering as such the journey towards an integrated Tc-99m supply chain ecosystem.A fundamental contribution of this research is the highlight on the necessary global vision of the radiopharmaceutical supply chain which is key to its integration and overall performance. The scientific contribution of this research is the development of a specific tool that supports and accompanies the integrated vision of the entire supply chain ecosystem, with select metrics designed in a perspective of continuous improvement.In its design, IRSCP opens door for the incorporation of powerful new technologies such as machine learning and artificial intelligence. For instance, the gathering of stakeholders to generate realistic solutions when an underperforming supply chain element is identified could be preceded by an automated generation of possible solutions through the application of machine learning and artificial intelligence algorithms.The tool is engineered to be flexible to support other supply chain designs or characteristics. It can be used for simulating the design of a new supply chain or the improvement of a current one. It can also be adapted for a use with other products with comparable characteristics such as other radiopharmaceuticals, dangerous goods, pharmaceutical products, or short shelf-life products. As such, IRSCP aims at bringing the supply chain performance management modelling practice to the next level.