Building a PET/CT Program in Sub-Saharan Africa: A Health-System Framework for Financing, Affordability, and Sustainable Implementation

Background: PET/CT is integral to modern oncology, yet access remains limited in Sub-Saharan Africa (SSA) because of capital requirements, radiopharmaceutical production complexity, workforce constraints, and weak reimbursement systems. We evaluated the modeled financial feasibility of a cyclotron-based PET/CT program using Cameroon as an illustrative national case and reframed implementation as a health-system planning problem rather than an equipment-purchase decision. Methods: A deterministic scenario model was developed over a 10-year horizon. The model was aligned conceptually with IAEA PET/cyclotron planning guidance, WHO OneHealth ingredients-based costing, and ISPOR principles for transparent decision modeling. The entry-level configuration comprised one PET/CT scanner, an 11–13 MeV negative-ion medical cyclotron, F-18 targetry, two synthesis modules, hot cells, a quality-control laboratory, backup power, and supporting infrastructure. Capital investment was modeled at USD 9 million as a planning estimate, with wide sensitivity analysis. Operating costs were separated into fixed, step-fixed, and variable components. Annual completed scan volumes of 500–5000 were evaluated, together with financing at 3%, 6%, 10%, and 12% APR, public capital support, operating subsidy, equipment availability, disease-specific demand, and alternative generator/satellite strategies. Results: At 6% financing, annual debt service for USD 9 million was USD 1.22 million. Modeled operating expenditure rose with activity from approximately USD 0.93 million at 500 completed scans to USD 1.77 million at 5000 scans because staffing and consumables were activity dependent. Total economic cost per completed scan declined from approximately USD 4311 at 500 scans to USD 598 at 5000 scans. If government provided the capital infrastructure, the operating cost to be recovered declined from USD 1865 to USD 353 per scan over the same activity range. A disease-specific incident-case model based on GLOBOCAN 2022 data for Cameroon showed that pathology confirmation, clinical eligibility, and referral completion materially constrain demand; at 30% histologic confirmation and 80% referral completion, approximately 1005 incident-case PET/CT examinations were generated under the base planning assumptions. Equipment availability of 80%, 90%, and 95% materially changed cost per completed scan in a 3000-slot program. Conclusions: Cyclotron-based PET/CT programs may achieve financial sustainability when patient throughput is sufficient, financing is appropriate, operations are reliable, and the surrounding cancer system can generate and act on evidence-based referrals. The model provides a transparent planning framework rather than empirical proof of sustainability and should be locally calibrated before investment decisions.