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Assessment of the Business Case for Positron Emission Tomography (PET) Scanning

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Assessment of the Business Case for Positron Emission Tomography (PET) Scanning Assessment of the business case for Positron Emission Tomography (PET) Scanning May 2007 NSTR Reference 01 Citation: Ministry of Health. July 2008. Assessment of the Business Case for Positron Emission Tomography (PET) Scanning. Wellington: Ministry of Health. Published in July 2008 by the Ministry of Health PO Box 5013, Wellington, New Zealand ISBN 978-0-478-31788-6 (Online) This document is available on the Ministry of Health’s website: http://www.moh.govt.nz About NSTR The National Service & Technology Review Advisory Committee (NSTR) is part of the Service Planning and New Health Intervention Assessment (SPNIA) Framework process. NSTR is responsible for horizon scanning, coordinating business case development, and analysing and evaluating proposals for change and business cases that are developed through the SPNIA Framework. NSTR currently makes recommendations to all the District Health Board (DHB) Chief Executive Officers (CEOs) and to the Ministry of Health’s Executive Leadership Team (ELT) on national service matters and new health interventions that have a national impact. NSTR’s role is to: • provide technical and strategic policy advice to the DHB CEOs and the Ministry’s ELT on health service configuration and health interventions that have a national impact • horizon scan for new health interventions that could be considered for formal assessment because of their potential value • horizon scan for services and health interventions that are obsolete, ineffective or inadequate, and therefore exit or cessation is likely to be appropriate • maintain a register of health interventions and potential disinvestments that have been recommended for assessment, and their status • develop, over time, a precedent-based threshold against which health interventions can be ranked on their appropriateness for introduction to the New Zealand public health system, or for their provision to cease • provide timely recommendations to the National Capital Committee on the service aspects of capital projects that require National Capital Committee approval • co-ordinate the development of business cases, including the evidence component • analyse and evaluate proposals for change and business cases and recommend their adoption or rejection to the DDG-CEO Group. Printed copies of the report can be obtained from: NSTR Convener Ministry of Health PO Box 5013 Wellington New Zealand Enquiries about the content of the report should be directed to the above address. Assessment of the Business Case for Positron Emission Tomography (PET) Scanning iii Contents About NSTR iii NSTR Recommendations 1 1 Introduction 13 1.1 Context 13 2 Development of the Options and Recommendations 15 2.1 Overview 15 2.2 Alternatives 15 3 Description of the technology, disease state and therapeutic interventions 21 3.1.1 Basic principles of PET Technology 21 3.2 PET applications 24 3.3 Importance of Cancer in NZ 25 3.4 Nature of interventions 27 4 Evidence of efficacy and effectiveness of PET 28 4.1 Methodology 28 4.1.1 Sources of evidence for the role of PET in clinical medicine 28 4.2 Evidence for PET for cancer management 28 5 Economic assessment 40 5.1 Overview 40 5.2 Potential costs and benefits 40 5.3 Costs identified 41 5.4 Likely patient benefit 44 6 Business implications 46 6.1 Capital expenditure and implementation costs 46 6.2 Forecast of cost to DHBs 52 6.3 Analysis of financial implications for provider of national service 54 7 Consultation summary 57 7.1 Summary of medical comment 57 7.2 Summary of research comment 57 iv Assessment of the Business Case for Poistron Emission Tomography (PET) Scanning 8 Specific areas of influence 59 8.2 Community acceptability 59 9.1 Cost-benefit assessment 64 9.2 Equity of Access 64 9.3 Size of the cyclotron 64 9.4 Strategic development 65 9.5 Next stages of analysis 65 Waikato Hospital Radiology Services - Positron Emmision Tomography (PET) Imaging Submission 8 Background 8 Key Issues 8 Demand for PET 9 C2: EVIDENCE FOR PET FOR CANCER MANAGEMENT (3) 33 Business/Programme Environment 50 Linked projects and processes 51 The objective is to provide a professional business case for PET Scanning that can be submitted to NSTR (via the Steering Group). 51 National Positron Emission Tomography Scanning Business Case Project 55 Key messages for the PET Scanning Business Case 55 National Positron Emission Tomography Scanning Business Case Project 56 Key messages for the PET Scanning Business Case 56 National Positron Emission Tomography Scanning Project in Context 61 Key messages for the PET Scanning Business Case Project 62 Project Inclusions 62 Assessment of the Business Case for Positron Emission Tomography (PET) Scanning v NSTR Recommendations The National Service and Technology Review Advisory Committee recommends that the DDG-CEO Group endorse the following: 1. Note that Positron Emission Tomography (PET) scanning is a widely adopted and proven technology, and further development will enhance its future value. 2. Note that PET scanning is currently available in New Zealand in an unco-ordinated and inequitable manner and that inaction will make the current situation worse. 3. Note that New Zealand’s current regulatory environment is fully equipped to cope with the introduction of PET technology and its consequential impacts. 4. Agree to support an initial investment in PET of one cyclotron and one full ring PET scanner. 5. Note that the estimated capital cost of this option is $13 million, the estimated annual operating cost is $4.3 million, and the estimated one-off implementation cost is $2–3 million. 6. Agree the following service configuration for the recommended investment. That: a. the PET service agreed should be established at Auckland DHB and/or the University of Auckland Faculty of Medicine and Health Sciences b. Auckland DHB recommends to the National Capital Committee how ownership of the assets should be treated between Auckland DHB and the University of Auckland Faculty of Medicine and Health Sciences c. the service should be a national service d. a National PET Advisory Committee be established, initially as a sub- committee of the National Cancer Treatment Working Party and these governance arrangements be reviewed after 18 months e. savings from PET scanning should be identified and quantified as part of the business case for capital funding f. the cost to DHBs should be off-set by the proceeds of any sale of isotopes. 7. Recommend that national CEOs agree that: a. funding for the service not be volume based, but be cost based and paid by DHBs per population-based funding share b. the source of funds should be from the annual population-based funding future funding track c. the appropriateness of moving to volume based funding be reviewed after two years or as part of the report back in recommendation 9 below. 8. Recommend that national CEOs note that funding PET scanning will result in less funding being available for other services. Assessment of the Business Case for Positron Emission Tomography (PET) Scanning 1 9. Agree that any further investment in PET should only be undertaken following a report back to NSTR that (amongst other things): a. includes evidence from trials of PET scanning, including from New Zealand, that demonstrates level 3 to 6 proof (Fryback and Thornbury methodology, Belgian HTA, 2006), or not, of its effectiveness b. analyses the number and type of scans undertaken, the influence on decision-making, patient outcomes, costs, etc that are administered in the last year of life in New Zealand c. analyses the equity of access to the PET service in New Zealand d. identifies changes to clinical practice required to secure the best health gain from PET scanning e. identifies changes required to secure cost savings from PET, including reductions in the use of other interventions and changes to clinical practice f. advises on appropriate costs and funding for scans, including the source of funds for further investment. 10. Agree that any further investment in PET require greater evidence of health gain and efficiencies than is currently the case and must require the support of NSTR to proceed; 11. Recommend that national guidelines for oncology practice be further progressed and request the National Cancer Treatment Working Party to provide advice to the Principal Advisor Cancer Control, Ministry of Health, on this matter during 2007, with a particular focus on PET. 12. Agree that any agreements to supply isotopes to private or other users must include a public health sector ‘first use’ clause. 13. Agree that following national DHB CEO support of NSTR’s recommendations that the next step should be for PET scanning to proceed to completion of a capital business case for submission to the National Capital Committee, followed by the establishment of a PET scanning implementation project. 14. Note that the capital business case will be the vehicle to address and confirm final costs, models of care, private sector and research linkages and other such implementation detail. 15. Advise the project team developing the capital business case that a facility design guideline for PET scanning facilities is being developed in 2007 as part of the Australasian Health Facility Guidelines project facilitated by the Centre for Health Assets Australasia (see www.chaa.net.au). 2 Assessment of the Business Case for Poistron Emission Tomography (PET) Scanning Business case for Positron Emission Tomography (PET) in New Zealand 28th May 2007 FOREWORD Positron Emission Tomography (PET) has become an indispensable imaging tool for the management of cancer in most developed countries. The markedly improved ability of PET to identify both the spread of cancer and the effectiveness of treatment, compared with current imaging modalities, has improved the lives of multitudes of cancer sufferers worldwide. PET scanning may indicate more extensive spread of cancer than indicated by other methods, thus sparing patients the need for futile operations or other aggressive treatments that would not be beneficial.
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