1562 – Streamlining Medicare Benefits Schedule Items for Positron Emission Tomography (PET) Project

Proposed streamlining of MSAC assessment of positron emission tomography (PET)

In response to stakeholder feedback, the Medical Services Advisory Committee (MSAC) is working with the Department of Health to develop a new approach to assessing applications for public funding of PET for use in the diagnosis and management of cancer. The new approach moves away from condition-based assessment and instead is seeking to assess the clinical utility of PET in relation to all fluorodeoxyglucose F 18 (FDG) avid tumours, regardless of the origin or site of the cancer. MSAC has advised that the initial work should focus on the use of PET for the initial staging of FDG-avid tumours. If this project proves successful, MSAC will investigate the suitability of this approach for the use of PET for diagnosis, surveillance and restaging. This approach may also have application to other investigative technologies. In developing this approach, MSAC acknowledges that PET is a proven technology and the performance characteristics of the technology are well understood. However, the key question for assessment and appraisal is whether use of PET in various stages of a patient’s treatment positively impacts on the patient’s management, outcome and is cost effective.

The Department has convened an expert working group to assist with the development of this new assessment approach, which was reviewed by the PICO Advisory Sub-Committee (PASC) at its December 2018 meeting. The Evaluation Sub-Committee (ESC) has provided feedback on the new approach, including providing feedback on a model to evaluate effectiveness and a triage model to determine suitable cancer types for the new assessment process. On 29 July 2021, the Evaluation Sub-Committee (ESC) presented its feedback to MSAC on the modelling to evaluate the effectiveness of FDG PET/CT for the initial staging of rare and uncommon cancer types.

MSAC supported the “Generic Economic Model” and the outcomes of its validation using breast and pancreatic cancer and then its further assessment using five case studies of rare cancer types.

MSAC agreed that the next step for this project is to develop parameters for how the outcomes of this pilot project can be translated into an implementation strategy for advising the Minister. An expert working group is working with MSAC and the Department to develop a set of “qualification” criteria that can identify those rare or uncommon cancer types for which MSAC could support public funding for FDG-PET/CT for initial staging.

MSAC acknowledged that the first phase of this project was FDG PET/CT for the initial staging of rare and uncommon cancer types. Rare and uncommon cancer types (approximately 200) comprise approximately 30 percent of all newly diagnosed cancers. MSAC noted that, as these cancer types have low patient numbers, they would not have sufficient evidence to progress through the current HTA pathway used for more common conditions.

MSAC considers that the outcomes of the validation process and case studies provide sufficient indications that the “qualification” criteria under development will identify those rare or uncommon cancer types for which FDG-PET/CT for initial staging will be both clinically and cost effective.The success of this pilot project has also permitted MSAC to consider extending this approach to assess the clinical utility and cost-effectiveness of FDG PET/CT for staging and re-staging of rare and uncommon cancer types.

We invite interested stakeholders to stay informed of the progress of this work by monitoring this webpage.

• PASC meeting: 6 to 7 December 2018
• ESC meeting: 
  • 7 to 8 February 2019
  • 13 June 2019
  • 10 to 11 October 2019
  • 12 June 2020
• MSAC meeting: 
  • 28 to 29 November 2019
  • 29 July 2021
  • 25 to 26 November 2021
  • 30 to 31 March 2023
  • 4 to 5 April 2024