Cardiovascular Business - May/June 2008 - (Page 28)

due diligenCe Catch 22: “no one will adopt SPeCT/CT widely until there is hard proof it’s cost-effective and without wide adoption, proof will be tough to obtain.” Kim allan Williams, mD, director of nuclear cardiology at the University of Chicago codes for billing. According to the American College of Radiology, it is appropriate to report separate codes for SPECT, CT and fusion localization only if each procedure is a complete study, medically necessary and interpreted separately. “The two types of information are incremental additives to each other in terms of predicting risk,” says Daniel Berman, MD, director of cardiovascular imaging at Cedars-Sinai Medical Center in Los Angeles. “The problem with the attenuation correction CONSULTANTS & PROFESSIONALS A large multinational corporation has aggressive plans to build global manufacturing capacity for various medical devices. As first part of the initiative we are seeking dialogues with Consultants proficient in the field of Bio-design engineering, Researchers, Technologists, Regulatory/Clinical Specialists with relevant 'start-to-finish' project experience for the following device areas: MEDICAL DEVICE • Vascular Stent Technologies • Catheter Technologies • Guidewires • Guide Catheters • Pacemakers System • Heart Valves • ICDs • Large Joint Implants • Spinal Implants The above will be associated in the capacity of Consultant(s) and will have access to, and facilitate technology transfer to fulfil project objectives. Interested Persons/Groups with relevant experience in their field of expertise should write in confidence stating brief CV and contact number to: Ms. Sussan Benny at sussan.beny@gmail.com is there is no added reimbursement for it. There is added value, but no added economic benefit.” There is some burgeoning cost-effectiveness data for CT with a caveat. “Chest pain centers in the ER are evaluating people with acute chest pain with CT or nuclear stress tests, and claim it is very clear that CT is more cost-effective than nuclear—but they are basing that on the reimbursement and the charges, which, again, are artificial,” William says. Clinical study results presented at the 2008 American College of Cardiology conference by James K. Min, MD, a cardiologist from New York Presbyterian/Weill Cornell in New York City, suggests that coronary CTA may be used as a cost-efficient alternative to nuclear stress testing to evaluate low- to intermediaterisk patients with suspected coronary artery disease. “Of course it is less costly, if you undervalue the procedure,” Williams says. In the case of Min’s study, simply saying that CTA is less costly over SPECT for CAD does not mean that it is truly cost-effective from a business standpoint. For example, in comparing two similar merchandise items, if one item is not selling as well as another, a common practice is to slash the price of one to drive sales or usage. This does not signify that one is more “cost-effective” than the other, but that one merely costs less. Figuring out the cost-effectiveness of SPECT/CT for cardiac disease detection will happen once there is significant appropriateness data available on patient benefit. “Then you need to have prospective studies to look at outcomes, which should be better than with CT or SPECT alone,” Williams says. “Then you can find out the select population that is benefiting from the combination and whether or not it is changing patient management.” Berman says that SPECT is still a very powerful modality and it is good without the added value of CT and is more promising for its whole-body scanning within the other disciplines of nuclear medicine than for cardiac disease detection. SPECT/CT does enable more accurate attenuation correction scanning in the heart. “It is as good as what we do with PET scanning and in that sense, we get around the problems of non-uniform soft-tissue attenuation that occurs in patients,” Berman adds. For example, a woman with large breasts might have a false-positive SPECT scan 28 Cardiovascular Business May/June 2008

Table of Contents Feed for the Digital Edition of Cardiovascular Business - May/June 2008

Cardiovascular Business - May/June 2008 Contents First Word Cover Story - Coronary CTA: Drafting the Strategic Plan Financing New Technologies: Early Adopters, Lease vs. Purchase, and Joint Ventures Clinical Study Digest: ACE or ARB: It's Your Choice Can Off-Hour D2B Times Be Reduced Without Breaking the Bank? Digital Image Management Primer: Integrating Echo SPECT/CT for Cardiac Disease Detection: An Economic Conundrum Integrating the Healthcare Enterprise Connects IT Systems News & Views Calendar Reader's Resources The Back Page

Cardiovascular Business - May/June 2008

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