Medicare Agrees to Cover PET Scans for Some Cancers
The Medicare program said Friday it will begin paying for an expensive test called positron emission tomography for use in the diagnosis of nearly half the cases of cancer each year in America’s elderly.
The decision could add hundreds of millions of dollars to the cost of the Medicare program. Each PET scan, which detects increased metabolic activity in cancerous tissue, costs about $2,000.
The Health Care Financing Administration, which oversees Medicare, had been heavily lobbied to add broad use of PET scanning to its menu of benefits. Early this month, 19 members of the Senate signed a letter to Donna Shalala, secretary of Health and Human Services, urging expanded coverage of the technology.
Friday’s decision was a compromise between two extreme positions: giving doctors a blank check to use PET or approving it only for the handful of uses in which its benefit has been proved beyond any doubt.
The decision will take effect no later than next July.
Last summer, UCLA asked for approval of PET scanning in 20 different cancers, as well as in Alzheimer’s disease and ischemic heart disease. Given the prevalence of those conditions in people over age 65, such broad coverage might quickly make PET scanning commonplace in the Medicare population.
HCFA approved PET for use in only six of the 20 cancers. However, within an approved cancer, a physician will basically be free to order it as he or she sees fit. The agency said it would pay for PET scanning as a backup diagnostic test in heart disease and referred the Alzheimer’s indication to an advisory committee for further study.
“I’m ecstatic. This is really fantastic,” said Michael Phelps, a chemist at UCLA, who invented PET in the 1970s and helped prepare the university’s application.
The chairman of the Medicare Coverage Advisory Committee, a group consisting mostly of academic physicians that provided general advise to the agency, also praised the ruling.
“I think the folks at HCFA tried very hard to do this in the most scientifically sound way, under very pressing time circumstances . . . . I think they did well,” said Harold Sox, chairman of medicine at Dartmouth-Hitchcock Medical Center.
PET scans do something that CAT and MRI scans don’t. PET reveals function as well as anatomical shape and location of tissue. Specifically, it identifies tissue that absorbs radioactively labeled glucose molecules--glucose being the main fuel of living cells.
No matter what organ they arise in, cancer cells consume glucose at about 20 times the rate of normal tissue. Because of that, malignant tumors “light up” on PET, often when they’re still invisible in other scans.
Medicare had agreed to pay for PET for very specific use in a few cancers where its benefit to patients had been proved by well-designed studies. Proponents said it was time to assume PET would be useful against virtually all cancers. They said Medicare should not wait for studies proving benefit in hundreds of clinical scenarios.
HCFA concluded that if a well-designed study proved PET useful for one particular purpose in one particular cancer, then the agency would cover PET for other uses in that same cancer.
The technology was approved for use against these cancers: lung; esophagus; colon and rectum; lymphoma; melanoma; and mouth and throat.
