Authors' objectives:

The objectives of this Health Technology Assessment (HTA) are threefold: - To evaluate the clinical utility and cost-effectiveness of positron emission tomography (PET) in different indications, based on a literature review; - To describe the current situation of PET in Belgium, including regulation, frequency of use and costs for the health care budget and compare the Belgian situation with other western countries; - To formulate recommendations for the organisation and financing of PET services in Belgium.

Authors' recommendations: Key messages: - Belgium has currently the highest number of PET scanners and the highest annual throughput amongst many Western countries. This cannot be justified nor explained on the basis of only scientific evidence or demographic data. - The number of approved PET scanners is higher than the need for PET services in Belgium. As a consequence, there is an overcapacity in PET. In addition, there are indications that some non-approved PET scanners are still operational in Belgium. - Although there is evidence that PET may offer some diagnostic advantages compared with other techniques, the evidence of improved clinical patient outcome is limited to a few indications. For most indications, there is no evidence that PET improves patient outcome. - A legal framework is needed for the outsourcing of FDG production to non-commercial academic PET centres with a cyclotron on-site. Although illegal, outsourcing occurs frequently in Belgium. - The fee per dose of FDG delivered is lower than the price charged for FDG by the companies with a marketing authorisation for FDG in Belgium. Reimbursement of FDG should be in line with requirements imposed for production and delivery of FDG. - In terms of diagnosis/treatment of patients with indications for which evidence exists that PET can improve patient outcomes, 3 PET scanners would be sufficient. Given the current prevalence of indications, for which PET imaging may be useful in terms of diagnosis accuracy, about 10 PET scanners would suffice for Belgium. - Because developments in diagnostic techniques may precede developments in treatment, the clinical effectiveness and cost-effectiveness of PET may only become clear in the longer term. Maintaining or creating an overcapacity for the sake of an uncertain future benefit is not only very costly but also not very useful given the continuing technological developments in this field. - Full use of existing (over)capacity and efficient use of health care resources are not compatible in the context of PET. Full capacity use of all approved PET scanners implies higher costs that are not proportional to improvements in patient outcomes that are essential to the patient as therapeutic planning, morbidity and mortality. - Health care policy makers have to make a trade-off between efficiency (i.e. using PET for indications where the clinical usefulness of PET is firmly established), implying the closure of some PET scanners, and other policy objectives, such as ensuring accessibility to PET services. - If the option of overcapacity of PET is chosen, there is an important opportunity for research with PET in Belgium. As public resources will be used for it, this research has to have clear objectives that are relevant for the society. If financial resources for research came from the health care budget this should be publicly transparent and should not overlap with other financial streams for research purposes towards the hospitals, e.g. from industry.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.kce.fgov.be/index_en.aspx?SGREF=5221&CREF=9326

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Belgium

Organisation Name: Belgian Health Care Knowledge Centre

Contact Address: Administrative Centre Botanique, Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium tel: +32 2 287 33 88 fax: +32 2 287 33 85

Contact Name: info@kce.fgov.be

Contact Email: info@kce.fgov.be

Copyright: Belgian Health Care Knowledge Centre (KCE)