Original Title: 18F-FDG en el estudio de la viabilidad miocárdica en pacientes con insuficiencia ventricular izquierda grave candidatos a revascularización

Authors' objectives: To assess the diagnostic efficacy to evaluate the myocardial viability of 18FDG-PET and its prognosis, as well as its budgetary impact.

Authors' results and conclusions: After reading abstracts to select studies, and the complete reading of those filtered studies, we selected two systematic reviews from 2007 and 2010, where we observe that the PET 18FDG is an alternative with a high sensitivity, ranging from 87 to 94.5% depending on the publication or if it is valued as a measure of metabolism or metabolism-perfusion. The specificity level ranged from 67 % to 78 %. The remaining descriptive variables of diagnostic efficacy were positive and similar in both the systematic reviews and the subsequent studies. The reviews are not of high quality since studies with different designs are mixed and the studies are of good quality but were conducted in small numbers of patients. We found one prospective randomized clinical trial with long-term results that specifically compared the prognosis of revascularization after PET versus no revascularization. The results of this study were positive in the long term, although subjected to analysis of patients who complied with recommendations and protocols. The annual economic impact of using PET compared to its alternatives (magnetic resonance imaging and/or echocardiography or SPECT) is estimated at around 2 million euros. The model was sensitive to the unit costs for each technology and its descriptors were variable according to each price list. The model is especially sensitive to the percentage of positive patients after the evaluation of myocardial viability, which is directly related to the high sensitivity of PET and the cost of revascularization alternatives. PET is a more sensitive alternative - with a reasonable level of specificity - than the other alternatives for assessing myocardial viability. However, the evidence from studies on diagnostic efficacy is of low quality. PET for myocardial viability has statistically significant forecast results, but only under ideal conditions. The budgetary impact is not very high, but the estimate of its magnitude has uncertainties.

Authors' recommendations: According to the results described above and the quality of the associated evidence, it is recommended to use PET for myocardial viability in centers with access to technology, where it is not carried out and where there is additional margin of use of the equipment.

Authors' methods: References on diagnostic efficacy and prognosis were searched in Medline through Ovid, Web of Science, Cochrane Library and Embase from 2007 to April 2019. We also assessed the quality of evidence, prioritising the availability of systematic reviews and prospective randomised clinical trials on the intervention specifically analysed. Finally, we estimated the potential budgetary impact of evaluating all patients for potential revascularization with PET versus not having PET under the perspective of the National Health System.

Project Status: Completed

URL for project: https://www.aetsa.org/publicacion/18f-fdg-en-el-estudio-de-la-viabilidad-miocardica-en-pacientes-con-insuficiencia-ventricular-izquierda-grave-candidatos-a-revascularizacion/

Year Published: 2021

URL for published report: https://www.aetsa.org/download/03_2019_AETSA_18FDG-PET_DEF_NIPO.pdf

Requestor: Spanish Health Ministry

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: Andalusian Agency for Health Technology Assessment (AETSA)