Evidence-based indications for the planning of PET or PET/CT capacities are needed

Purpose

To identify evidence-based indications for PET/PET–CT scans in support of facilities planning and to describe a pilot project in which this information was applied for an investment decision in an Austrian region. The study updates a Health Technology Assessment (HTA) report (2015) on oncological indications, extending it to neurological indications and inflammatory disorders.

Methods

A systematic literature search to identify HTA reports, evidence-based guidelines, and systematic reviews/meta-analyses (SR/MA) was performed, supplemented by a manual search for professional society recommendations and explicit "not-to-do's". A needs-assessment was conducted in the context of the pilot study on investing in an additional PET–CT scanner in the Austrian region of Carinthia.

Results

Overall recommendations for indications as well as non-recommendations for the three areas (oncology, neurology, and inflammatory disorders) were compiled from the 2015 PET–HTA report and expanded for a final total of ten HTA, comprising 234 (positive and negative) recommendations from professional societies and databases, and supplemented by findings from 23 SR/MA. For the investment decision pilot study in Carinthia, 1762 PET scans were analyzed; 77.8% were assigned to the category "recommended evidence-based indications" (54.7%), "not recommended" (1.8%) or "contradictory recommendations" (21.3%). The remaining could not be assigned to any of the three categories.

Conclusions

The piloting of PET capacity planning using evidence-based information is a first of its kind in the published literature. On one hand, the high number of PET scans that could not be ascribed to any of the categories identified limits to the instructive power of the study to use evidence-based indication lists as the basis for a needs-assessment investment planning. On the other hand, this study reveals how there is a need to improve indication coding for enhanced capacity planning of medical services. Overall recommendations identified can serve as needs-based and evidence-based decision support for PET/PET–CT service provision.