 Abstract of the lecture presented at the 12th ASEAN Association of Radiology Congress, Sep 2004 by Professor Rodney J Hicks, Director, Centre for Molecular Imaging, the Peter MacCallum Cancer Centre, Melbourne, Australia
The rapid growth in sales of PET/CT scanners throughout the developed world has raised concerns regarding the cost implications of introducing this technology into routine clinical practice. Several health technology assessment reviews performed by different countries around the world have questioned the cost-effectiveness of PET, despite generally conceding the superior diagnostic capability of this modality compared to conventional structural imaging techniques.
PET has been a relatively expensive modality since its introduction. This has been based on the combination of relatively low throughput, expensive instrumentation and the requirement for tracers that have only a short physical half-life.
PET/CT scanners are more expensive again than stand-alone PET scanners, potentially adding further to the cost of these procedures. In an economic environment where health resources are finite or more often, overstretched, it is reasonable to ask whether improved diagnostic performance is sufficient justification for the introduction of new high-cost technologies. There is however cogent reasons to suggest that improved non-invasive evaluation of disease may be ultimately cost saving in modern medical practice, particularly if the cost drivers of PET/CT can be addressed through economies of scale.
Although diagnostic imaging is a significant contributor to overall health costs, in cancer, it represents only a fraction of the cost of cancer therapies. Since the selection and delivery of therapy to cancer therapies is made on the basis of the extent of disease, more accurate definition of the extent of disease is critical to the rational practice of oncology. While aggressive locoregional therapies such as surgery and chemoradiotherapy offer the best chance of cure for many malignancies, they are expensive and morbid procedures with measurable acute mortality that can only be curative if all sites of diseases can be included in the treatment field.
Due to inadequacies of current staging techniques, patients are often only found at surgery to have been inoperable or alternatively, many patients will undergo radical treatment only to relapse very shortly thereafter with disease that was clearly present but unrecognised or undetectable at the time of that treatment.
The superior ability of PET/CT to detect occult sites of metastatic disease can prevent futile attempts at curative treatment, potentially saving the costs and morbidity associated with it. Further, by modifying treatment delivery PET/CT may also improve the likelihood of cure in those patients who remain candidates for treatment with curative intent.
In the post-treatment setting, residual structural abnormalities can lead to considerable anxiety, ongoing surveillance costs and, in some cases, costs related to “salvage therapies”. In cases where no disease exists, these costs are unwarranted. PET/CT could reduce these costs by allowing a conservative approach to those patients with negative scans. Preliminary data suggests that even at current PET costs, cost savings might accrue from including PET in the diagnostic algorithm of cancer evaluation at initial staging, in therapeutic monitoring and in surveillance/restaging. It is however feasible to significantly reduce PET costs through economies of scale. By allowing higher throughput PET/CT can offset substantially the increased instrumentation costs and provide additional benefits in terms of more efficient use of PET radiotracers, staff and physical infrastructure. Also, as the installed base of PET/CT scanners increases, amortisation of development costs, production efficiencies and improved maintenance costs will all serve to decrease the overall cost of clinical studies.
To view the slides of the presentation, click here You may need to  before you can open the PDF file. |
