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Economic Evaluation of PET and PET/CT in Oncology: Evidence and Methodologic Approaches

Andreas K. Buck, Ken Herrmann, Tom Stargardt, Tobias Dechow, Bernd Joachim Krause and Jonas Schreyögg
Journal of Nuclear Medicine Technology March 2010, 38 (1) 6-17; DOI: https://doi.org/10.2967/jnmt.108.059584

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    PET/CT represents one of the medical imaging modalities with the largest growth worldwide. In 2009, approximately 2,000 PET/CT scanners were installed in the United States and approximately 350 were installed in Europe. Considering a population of about 307 million in the United States and 830 million in Europe, the United States has installed about 6 times as many scanners as all of Europe but has only one third the population. (Courtesy of Siemens/CTI.)

  • FIGURE 2. 
    FIGURE 2. 

    In Europe, introduction of PET/CT hybrid scanners has also led to an increase in their installations. Compared with the United States, however, a less accelerated growth has been observed. In 2009, 70 scanners were installed in Germany and 350 in all of Europe. (Courtesy of Siemens AG.)

  • FIGURE 3. 
    FIGURE 3. 

    PET/CT has greater diagnostic accuracy than separately performed imaging modalities. In this patient at initial diagnosis of colorectal cancer, coronal (A) and sagittal (B) PET/CT images indicate increased metabolic activity of malignant primary (arrows); transaxial CT (C) and PET/CT (D) images indicate synchronous bone and liver metastases (arrows), leading to change from curative resection to systemic chemotherapy; and transaxial CT (E) and PET/CT (F) images at another level indicate primary tumor.

Tables

  • TABLE 1

    Reimbursement of PET and PET/CT in United States (59) and Germany (60)

    United StatesGermany
    IndicationInitial treatment strategySubsequent treatment strategyInitial treatment strategySubsequent treatment strategy
    Head and neck cancerCC——
    Esophagus cancerCC——
    Gastric cancerCNOPR——
    Small intestinal cancerCNOPR——
    Colon and rectal cancerCC——
    Anal cancerCNOPR*——
    Hepatocellular carcinomaCNOPR——
    Gallbladder and cholangiocellular carcinomaCNOPR——
    Pancreatic cancerCNOPR——
    Cancers of retroperitoneum and peritoneumCNOPR——
    Non–small cell lung cancerCCCC
    Small cell lung cancerCNOPR——
    MesotheliomaCNOPR——
    Cancers of mediastinum; thymus carcinomaCNOPR——
    Sarcoma of boneCNOPR——
    Soft-tissue sarcomaCNOPR——
    MelanomaC/—†C——
    Skin cancers (nonmelanoma)CNOPR——
    Breast cancerC/—†‡C——
    Uterine cancerCNOPR——
    Cervix carcinomaC/NOPR§C——
    Ovarian cancerCC——
    Prostate cancer—NOPR——
    Bladder cancerCNOPR——
    Kidney and other urinary tract cancersCNOPR——
    Primary brain tumorsCNOPR——
    Thyroid cancerCC/NOPR‖——
    Other endocrine tumorsCNOPR——
    Cancer of unknown primaryCNOPR——
    LymphomaCC——
    MyelomaCC——
    LeukemiaNOPRNOPR——
    Neuroendocrine tumorsCNOPR——
    Other cancersCNOPR——

    • ↵* Some Medicare contractors include anal cancer in their local coverage of “colorectal cancer”; for PET facilities served by those carriers, PET for subsequent treatment evaluation of anal cancer would be a covered indication.

    • ↵† PET is not covered for initial staging of axillary lymph nodes in patients with breast cancer and of regional lymph nodes in patients with melanoma but is covered for detection of distant metastatic disease in high-risk patients with breast cancer or melanoma.

    • ↵‡ PET is not covered for “diagnosis” of breast cancer to evaluate suggestive breast mass. However, PET is covered for initial treatment-strategy evaluation of patient with axillary nodal metastasis of unknown primary origin or patient with paraneoplastic syndrome potentially caused by occult breast cancer.

    • ↵§ Patient must have prior CT or MRI negative for extrapelvic metastatic disease for PET to qualify as covered indication for initial treatment-strategy evaluation. Patients who do not qualify for this covered indication (e.g., because CT or MRI was not done or because either CT or MRI showed extrapelvic metastatic disease) can be entered on NOPR.

    • ↵‖ To qualify as covered indication for subsequent treatment-strategy evaluation, thyroid cancer must be of follicular cell origin and have been previously treated by thyroidectomy and radioiodine ablation and patient must have serum thyroglobulin level > 10 ng/mL and negative whole-body 131I findings. Patients who do not qualify for this covered indication (e.g., because tumor is not of follicular cell origin, thyroglobulin is not elevated, or 131I whole-body imaging was not performed or is positive) can be entered on NOPR.

    • C = covered (not eligible for entry in National Oncologic PET Registry [NOPR]); NOPR = covered only with entry in NOPR; — = not covered nationally (not eligible for entry in NOPR).

    • Modified from http://www.cancerpetregistry.org/indications_facilities.htm.

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