New Study Finds PET Imaging Not Associated with Reduction in Downstream Healthcare Utilization and Spending Compared to Conventional Imaging
Cardiac PET, an imaging test for evaluation of coronary artery disease, is advocated by some nuclear cardiologists for its high imaging quality. Proponents for cardiac PET testing believe that the high resolution can prevent a need for additional, potentially invasive tests and procedures later on and reduce downstream medical spending. Other nuclear cardiologists disagree suggesting that conventional imaging tests such as single photon emission computed tomography (SPECT) are more accessible to patients, widely used in clinical practice, and less costly than PET imaging.
A SPECT camera costs $400,000 to $600,000, while a PET-CT scanner can cost around $2 million. The shorter half-life of PET (compared to SPECT) radiotracers presents challenges with handling and time windows during which images can be acquired. The high cost associated with managing a cardiac PET program and the need for a high level of reimbursement for PET tests can create economic incentives for choosing PET over conventional imaging tests like SPECT and stress echocardiography. As with any more costly technology, it is important to ask: is the additional cost of PET offset by reduced downstream costs or better outcomes?
According to the results of a new study published in the Journal of Nuclear Cardiology, the answer is no.
A real-world study by HealthCore and AIM Specialty Health compared first-line PET imaging and first-line conventional imaging use (SPECT and stress echocardiography) among CAD naïve patients using administrative claims data for Medicare fee-for-service members from 2014 through 2016. Researchers found that PET imaging did not have the desired benefit of reducing the need for additional invasive procedures, and was not associated with reduction in spending compared to conventional imaging. In fact, in patients undergoing PET imaging, higher levels of invasive cardiac services and increased healthcare costs were observed.
“Patients who had index PET imaging had 15 invasive cardiac services per 1,000 patient months compared with 13 per 1,000 patient months for those with index conventional imaging,” said Dr. Abiy Agiro, director of translational research at HealthCore. “This represents about a 12 percent increased rate for invasive cardiac services such as angiography, percutaneous coronary intervention, and coronary artery bypass grafting for patients getting index PET imaging instead of conventional imaging tests.” In terms of medical spending by Centers for Medicare and Medicaid Services (CMS), PET imaging was associated with increased spending of $584 per patient per month (PPPM) compared to conventional imaging (PET imaging: $2,358 PPPM; Conventional imaging; $1,774 PPPM).
This study represents the largest and most up-to-date analysis directly comparing first-line PET imaging and first-line conventional imaging use among CAD naïve patients. Researchers used a five percent random sample of Medicare fee-for-service members for analysis, making the findings highly generalizable to the majority of Medicare members covered by CMS.
“It is not clear why patients undergoing PET required more invasive services following initial imaging,” said Dr. Thomas Power, senior medical director of cardiology and sleep medicine for AIM Specialty Health. “Despite our best efforts to match the two populations, it may be that the PET group had more complex conditions. Regardless, our analysis suggests that the increased cost of PET imaging is neither clinically nor economically justifiable. What we can conclude is that there is a range of viable testing options for CAD patients beyond PET, and at the end of the day, first-line imaging decisions should be based on clinical parameters rather than economic incentives that necessitate increased use of PET imaging.”