Positron emission tomography/ Computer tomography (PET/ CT): need-assessment for planning

Research areas: Oncology, High tech medicine

Duration: September 2014 - December 2014
Publication: LBI-HTA Project report No. 77: https://eprints.aihta.at/1045

Language: German
Suggested by: Wiener Gesundheitsfonds (WGF)

Background:
PET/ positron emission tomography is a nuclear medicine imaging procedure that produces cross-sectional images of living organisms by making the distribution of a lightly radioactive substance (radiopharmaceutical) in the organism visible. These tracer compounds can then be used to track biochemical and physiological processes in vivo. For more than 10 years devices have been on the market that combine a PET scanner with a computer tomography (CT). The PET images that are spatially and anatomically poorly classified can be reliably associated with anatomical structures through the simultaneously created CT-scan, a process with very good spatial resolution.

PET or PET/ CT devices have spread quickly in spite of very controversial discussions. Approximately 90% of PET applications are seen in the field of oncology, in diagnostics, stage determination, treatment and recurrence monitoring, detection of residual tumor after chemotherapy and radiotherapy, radiotherapy planning. The controversy arises from the different points of view: on the one hand oncologists emphasize the technical possibilities of diagnostics; on the other hand others highlight the lack of evidence of patient-benefits through changing/ improving treatment decisions.

Planning of the number of PET devices for a given population is commonly based on estimates of users (oncologists) and on benchmarks of other Western countries, and rarely on analyses of actual need.

Aim of project:
The aim of the project is an overview of "evidence-based" and “appropriate” use of PET/ CT in diagnosis, staging and monitoring, which will serve as support for need-based planning and reimbursement decisions.

Research questions:

1. What PET/ CT planning figures (based on analytical needs-oriented approaches) are available in OECD countries, and what are the recommendations of these planning documents?
2. Which patient benefit analyses (HTAs) are published that evaluated PET/ CT in different cancer indications and what conclusions do these assessments draw?
3. For indications and under what conditions is the use of PET/ CT explicitly discouraged?
4. Which future PET/ CT applications are discussed in scientific forums (conferences)?

Methods:

1. Overview of PET/ CT planning documents and their results (indicators for planning in Austria)
2. Overview of published HTAs about the benefits and value of PET/ CT in treatment decisions in oncology
3. Overview of indications that are explicitly termed "inappropriate" for PET/ CT
4. Rough overview of PET research with insight into future indications

Time schedule/ milestones (in months):

September 2014: Systematic literature search of HTAs; Hand search of planning documents.
October 2014: Hand search of diagnostic pathways and guidelines; Search in disinvestment databases.

November 2014: Structuring and evaluation; interviews on future applications.
December 2014: Reporting, external review, completion.

References:

IQWIG (G): Positronen-Emissions-Tomographie (PET) : https://www.iqwig.de/