While overall imaging costs are increasing faster than overall Medicare cancer care costs, 18F-FDG PET or PET/CT account for approximately 1.5 percent of Medicare cancer care expenditures, according to an economic analysis published online in a December supplement to the Journal of Nuclear Medicine .
U.S. healthcare costs “are increasing faster than the gross domestic product (GDP), and the growth rate of costs related to diagnostic imaging exceeds those of overall healthcare expenditures,” wrote Yang Yang, MD, and Johannes Czernin, MD, from the department of molecular and medical pharmacology at the David Geffen School of Medicine at the University of California, Los Angeles. “Because 18F-FDG PET/CT has the reputation of being expensive, it is important to inform patients and healthcare professionals about its actual contribution to overall public (i.e., not privately insured) cancer care expenditures. It is insufficient to simply consider the costs of a single therapeutic or diagnostic approach without considering its overall impact on the downstream costs of healthcare services.”
Overall U.S. healthcare costs amount to more than $2 trillion per year, and healthcare-related expenditures are predicted to account for 20 percent of the U.S. GDP in 2015, the study authors wrote. “Cancer care costs are increasing and, including loss of productivity, contribute approximately 10 percent to overall healthcare costs in the U.S. Direct cancer care costs in the U.S. totaled $124.57 billion in 2010 and are expected to increase to $173 billion in 2020.”
Total Medicare expenditures amounted to approximately $327 billion in 2006, and Medicare fee-for-service payments for cancer care accounted for approximately $32.1 billion (10 percent) of these expenditures. In 2004, Medicare paid $5.3 billion for cancer drugs, and annual drug expenditures have continued to grow at double-digit rates.
Imaging is among the "most frequently used tools" for detecting and monitoring tumor therapy response, which "has led to the increased use of many imaging modalities in cancer, but annual growth rates have been highest for PET,” wrote Yang and Czernin, who cited Dinan et al’s study that found that that imaging expenditures grew at annual rates of 5.1 percent to 10.3 percent, whereas annual growth rates for overall cancer care costs ranged from 1.8 percent to 4.6 percent ( JAMA 2010;303:1625–1631 ). Based on the same study, the annual use of PET and PET/CT increased by 35.9 percent to 53.6 percent, depending on the cancer type.
However, despite its increase in use, Yang and Czernin pointed out reimbursements for PET have “dropped precipitously, since its introduction, from $1,980 (excluding professional fees and costs of radioisotopes) in 1998 to $1,151 (including costs of radioisotopes) in 2010; the largest reduction in reimbursements occurred after the expiration of the ‘new technology’ status of PET. CMS [Centers for Medicare & Medicaid Services] also used facility costs divided by number of scans performed to set a new reimbursement at $1,375 in 2002.”
Using Dinan et al’s reported numbers of imaging procedures and applying 2006 mean reimbursements, Yang and Czernin estimated that PET contributed 21 percent to overall Medicare imaging costs and accounted for approximately 1 percent of total Medicare cancer care expenditures.
In their conclusion, Yang and Czernin called for well-defined prospective multicenter studies that can assess "actual rather than modeled healthcare costs and outcomes for various cancers and scenarios, such as neoadjuvant and adjuvant cancer treatments," to be initiated.