Molecular Imaging Insight - September 2007 - (Page 14) Q What are some of the newest applications in molecular imaging? roDney HiCKs, MD: In my particular area, the greatest interest is oncology. I work at a cancer center, and the major purpose is to develop new tracers or individualizing the care to an individual patient. This is critically important in cancer because of the diversity of the biology that we’re looking at, and as we have progressive advances in molecular biology, understanding what’s driving diseases, having tracers that can identify those processes, imaging them in the individual fashion and then testing whether we’re modulating those signals with imaging. It becomes an integrated process as part of the care of those patients, and I’m very excited about that advance. “I think the biggest challenge lies in that there’s a lot of the basic biomedical research done—but there’s very little that is being done around the medical economic aspect.” Douglas Hadley, MD, medical officer and director of Cigna’s coverage policy unit Q How can we accelerate adoption rates? What are some examples of using the technology to improve quality of care? CerQuiera: To implement a technology, we need to really become much more efficient at what we do in terms of the way we perform the studies and improving the accuracy of the studies. I think, as Dr. Hicks said, identifying more specific markers so that these imaging instruments can more closely identify biological processes will make a better diagnosis, correct diagnosis earlier and help to modulate the type of treatment that needs to be used for the patient. Then it also will monitor for efficacy of the treatment or undue side effects and then change it appropriately. Those would be desirable features. What other issues are important with molecular imaging technology? HiCKs: One of the focuses we often have with [payors] and individual patients is the unit and cost of the PET/CT versus a CT, and that seems inordinately higher to many patients. Why should I pay $900 vs. $300, or $2,000 vs. $1000— whatever the cost is in your particular jurisdiction. The reality is that the decisions that are made from the diagnostic test are so important, and the expenditure that flows from that is so high. We recently looked at the cost in our center of the PET service. It’s less than 1 percent of the total cost in our institution, and we’re a dedicated cancer center. yet, everyday major decisions are being made on how the 99 cents in every dollar are being spent on the basis of that PET scan. (To read more from Dr. Hicks on the cost of PET, please see the cover story on page 3.) Trysla: Not only is there a human face or a patient face to what you just described doctor [Hicks], but there’s a public policy role. There’s a critical role for education of patients, and a public policy role to show the value and to educate people about the critical roles that diagnostic services play in the treatment of disease. It’s something that we in Washington have to work to help quantify and bring that value equation to bear to policymakers, to patients as well as to decision-makers in the government. reiTerMann: We usually drive for approving the clinical efficacy, but I think we also should strive for what is the financial efficacy of these new methods. Globally we see a tremendous increase in healthcare cost. Healthcare is now 16 to 17 percent of the GDP [gross domestic product] worldwide. There is tremendous pressure. We [need to] provide the analysis of the financial impact of [various] procedures. PeTroCelli: Part of it is that to make money, you have to spend money. In this case, to save money, you have to spend money. We need to develop additional technologies, [such as] biomarkers backing up to the point at which we can make the diagnosis before the disease is clinically evident to be really effective at managing it. To do that, we have to spend millions and millions of dollars in research and development. This is an evolutionary process where we take a small step which leads us to another small step which leads us to another small step. Eventually each of these little evolutions, when you add them all up, becomes revolutionary. But to get there, we have to spend research dollars and that means public funding as well as private funding as well as partnerships between industry, pharma, universities and the public and payors. We need to develop a general policy on how we’re going to handle this and pool our resources so that we’re not working against each other but in a concerted effort to use that money in the most effective way possible. Q Q Where do your particular challenges lie? How do you plan to respond to major changes in the standard of care as molecular imaging technologies are adopted? And how do you see the payment model shifting to accommodate them? HaDley: I agree with many of the comments that were made. Unfortunately when something new comes on, we tend not to get rid of the old. We tend to add it on. So we just keep adding layer upon layer. I think the biggest challenge lies in that there’s a lot of the basic biomedical research done—but there’s very little that is being done around the medical economic aspect. Trysla: There’s an old saying in healthcare: healthcare is expensive, but wait until it’s free. It’s going to be an incredible challenge to fund the technology for the future, and you’ve got to be able to bring those critical pathways and value equations to bear, but you also have to show and have a patient’s voice in this. The environment—the fastest growing proponent of Medicare—at least the Medicare side, is diagnostic services, and it’s colored with evidence of selfreferral or financial incentives to drive and do more testing. It’s not really focusing on the value of the patients, and that patient voice has to be captured. It’s not just the technol- 1 Molecular Imaging Insight September 2007
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