Molecular Imaging Insight - September 2007 - (Page 15) ogy, but it’s also the business side of practicing medicine that has colored the cynicism around the adoption of this technology. It is critically important that we change the discussion back to what’s best for the patient and the advancements in medicine. PeTroCelli: There are other ways that we ought to start looking at things, too. We have to come up with new and creative ways to do those things, and some of those would be, for example, the National Oncology PET registry where we developed a methodology between industry and government to be able to start to pay for PET scans, for things that we were not paying for before, but collecting data on then so that we would get evidence-based decision making much sooner than we could otherwise. If we had to do individual trials for those cancer patients, we probably would be looking at five to seven years. And I can’t imagine how many hundreds of millions of dollars it would have taken. This approach has gotten results within two years because we did it on a national scale, and we did it in a coordinated way throughout the United States. CerQuiera: The truth is we can do all these things correctly. We can show value. We can show efficacy. We can show efficiency and effectiveness, but what we’re doing is we’re keeping people alive longer, and in my own area of cardiology, where people used to die from heart attacks, that was cheap. Once you’re dead, you don’t run up any bills. But now we’re preventing people from dying from their heart attacks, but they have heart failure. So there are bound to get more tests. They get more medications, and so we’re doing the right things, but the reality is the cost. Even if we’re very efficient at doing these things, it’s going to go up, and you come back to the pairs. We can do all of these things. We can generate evidence-based medicine, but the bottom line is appropriate efficacy, value—that it’s still going to be more tests. How do we deal with that? HiCKs: When we set to [look at this] and established a program 12 years ago now, most people in Australia told me that I was crazy. This was a research tool and it had no future at all. [They’d say] you’ve got to show us the evidence. you want randomized studies. you want to follow-up those to show that this particular diagnostic test saved this patient’s life when there’s a very long link between a test and that kind of outcome. yet, [through the research] we’re able to show in many, many diseases—lung cancer, colorectal cancer, malignant melanoma, ovarian cancer—when all traditional tests had been done and management decisions are being prospectively recorded for that patient by the managing clinician that it changed their course of management in between a third and a half of all patients. KuwerT: I’d also like to add some points. The first thing is that I think you’re right, Dr. Cerquiera. My personal belief is that medicine will become even more expensive than it is now. And this is more or less a consequence, not of imaging, but of developing new therapies. If you think of new medication, for example the treatment of colorectal carcinomas was maybe ten years ago a surgery, and that was that. And then there came chemotherapy, and this added further [to the expense]. In Germany, it may be $5,000 or $500 euros per year per treatment. And now they’re coming up with new compounds. They cost further $10,000 euros per year, and there is evidence showing that these treatments are efficient for the patient and prolong survival. So these are costs that we will have to cover when we want to help people deal with their disease, and imaging is just a very small part of the increase in costs that will come. The second point is that we are getting in a situation, in my eyes, that is very difficult to control. This is due to the fact that the complexity of healthcare is steeply increasing. We have a very record turnover in technologies if you look at imaging modalities. So when we want to produce evidence then we just don’t have the time, since when we have produced an evidence that maybe PET would be better suited or MRI for a certain purpose, then PET has evolved and is not the PET that we have studied in our evidence-based studies. And the third point also is maybe a critical remark. I think [another] major challenge is the complexity. We as clinicians always want to do the best for our patients. We have to have systems that somehow help us to avoid unnecessary procedures. HaDley: I think one of the problems with this whole area is that companies, such as Siemens, are able to advance the technology faster than we can collect the evidence to support the underlying clinical efficacy, and so that is one of the problems that we see. The technology evolves faster than we can really understand it. I also agree with you that as a new technology—[such as] PET scans, molecular imaging and so forth—becomes “[Another] major challenge [of molecular imaging technologies] is the complexity. We as clinicians always want to do the best for our patients. We have to have systems that somehow help us to avoid unnecessary procedures.” Torsten Kuwert, MD, Chairman of the Department of Nuclear Medicine, University of Erlangen-Nuremberg, Germany adopted, many insurance carriers will adopt prior authorization rules which are not really popular with physicians. But they are a way of being able to accept a new technology and then review the cases. We like to review new technologies for a year or two. If we find that the requested uses are the vast majority of the time appropriately used, then we can take it off of prior authorization. That’s one response that will allow earlier adoption by insurance carriers because then we have some protection, and we’re also promoting the critical pathways so that when we get requests for that we can compare those to what leading clinicians feels are the correct uses of those technologies. That is one way to help deal with financing for new and emerging technologies. MolecularImaging.net Molecular Imaging Insight 1 http://MolecularImaging.net
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.