Positron emission tomography: experience with PET and synthesis of the evidence (INAHTA Joint Project)

Adams E, Asua J, Conde Olasagasti J, Erlichman M, Flynn K, Hurtado-Saracho I
Record ID 32000008162
Authors' objectives:

This report documents PET use and related public health coverage in countries represented by INAHTA members and synthesizes technology assessments of PET conducted by INAHTA members and three private US organizations. It considers all PET systems, that is, conventional full ring models, newer partial ring models and SPECT cameras modified for imaging positron emitters.

Authors' recommendations: PET's availability is still quite limited, as evidenced by the low numbers and relative under use of scanners in each country or region. Most health systems used their PET scanners for both research and diagnostic purposes, but there were wide variations in use across systems. Local regulatory policies and the availability of private funding sources likely contributed to these differences. The vast majority of reimbursed clinical PET activity is concentrated in relatively few health systems and is confined to comparatively few indications. - Public health systems in Australia, Switzerland, Denmark and the US (VHA) conducted 85% of the activity. - The most frequently covered PET indications, presented in descending order, were for diagnosing head and neck cancer, lung cancer and lymphoma followed closely by differentiating brain tumor from radiation necrosis and diagnosing colorectal cancer, breast cancer and melanoma. - 70% of the oncology activity comprised melanoma, lung cancer staging, and an undefined category of other. The vast majority of neurology activity was for distinguishing brain tumor from radiation necrosis and for localizing epileptic foci in potential surgical candidates with intractable epilepsy. Many health systems refer to US experiences, particularly Medicare policy, to establish local reimbursement policy. In the US in 1997, supporters of clinical PET were instrumental in changing FDA regulation of PET drugs. As a result, Medicare has expanded coverage of PET scans beyond cardiac perfusion imaging to include diagnosing indeterminate solitary pulmonary nodules, recurrent metastatic melanoma and recurrent colorectal cancer and staging non-small cell lung cancer, Hodgkins and non-Hodgkins lymphoma. Regarding PET's utility, evidence of diagnostic accuracy is largely based on traditional full ring PET, is limited by bias and often relates only to small patient numbers. In all of the advocated clinical indications there was uniform agreement that critical research is needed to define the clinical and economic consequences of using PET on treatment decisions and health outcome relative to other methods now in clinical use. Many INAHTA agencies identified clinical PET as a major research priority and are initiating rigorous evaluation efforts. Most recommended that, if used at all, PET should be used under research protocols designed to evaluate PETs relative cost-effectiveness.
Authors' methods: Overview
Project Status: Completed
Year Published: 1999
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: United States
MeSH Terms
  • Costs and Cost Analysis
  • Diagnostic Imaging
  • Diagnostic Techniques and Procedures
  • Tomography, Emission-Computed
Organisation Name: VA Technology Assessment Program
Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;
Contact Name: elizabeth.adams@med.va.gov
Contact Email: elizabeth.adams@med.va.gov
Copyright: INAHTA
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.