Assessment of the business case for Positron Emission Tomography (PET) Scanning

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:
   1. the PET service agreed should be established at Auckland DHB and/or the University of Auckland Faculty of Medicine and Health Sciences
   2. 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
   3. the service should be a national service
   4. 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
   5. savings from PET scanning should be identified and quantified as part of the business case for capital funding
   6. the cost to DHBs should be off-set by the proceeds of any sale of isotopes.
7. Recommend that national CEOs agree that:
   1. funding for the service not be volume based, but be cost based and paid by DHBs per population-based funding share
   2. the source of funds should be from the annual population-based funding future funding track
   3. 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.
9. Agree that any further investment in PET should only be undertaken following a report back to NSTR that (amongst other things):
   1. 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
   2. 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
   3. analyses the equity of access to the PET service in New Zealand
   4. identifies changes to clinical practice required to secure the best health gain from PET scanning
   5. identifies changes required to secure cost savings from PET, including reductions in the use of other interventions and changes to clinical practice
   6. 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).

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