|
Die amerikanische Entscheidung zu PET
Im July 2000 beantragten Drs. Michael Phelps and Sam Gambhir
die Zulassung von PET für die gesetzlichen Krankenkassen der
USA bei der HCFA (Health Care Financing Administration, jetzt Centers for Medicare & Medicaid Services CMS, www.cms.gov).
Die HCFA forderte Unterstützung in der Begutachtung
durch die AHRQ (Agency for Health Research and Quality). Die AHRQ veranlasste,
dass der Antrag validiert wird mit Hilfe eines EPC (Evidence based
Practice Center). Die NEMC (New England Medical Center of Tufts University)
erbrachte diese Validierung. Der EPC führte eine Literaturrecherche
für jede beantragte Indikation durch. Hierbei berücksichtigten
Sie über 500 Artikel zu PET aus den Jahren 1990-2000.
Um eine öffentliche Diskussion zu PET zu ermöglichen,
wurde zusätzlich das MCAC (Medicare Coverage Advisory Committee)
um Rat gebeten. Dieses Gremium tagte im November 2000 nach Vorträgen
der Antragsteller und anderer. Zusätzlich in den Entscheidungsprozess
eingebunden wurden der "technology assessments" veröffentlicht
2000 von Blue Cross Blue Shield, der "Report of the Commonwealth Review
of Positron Emission Tomography" (ebenfalls 2000).
Im Dezember 2000 schließlich erweiterte die HCFA die
Indikationsliste der amerikanischen gesetzlichen Krankenversicherungen
auf insgesamt 6 Tumorsorten für Diagnosefindung, Staging und Restaging.
Details dieser Entscheidung sind
hier
nachzulesen.
Clinical Condition |
Effective Date |
Coverage |
| Solitary Pulmonary Nodules (SPNs) |
January 1, 1998 |
Characterization |
| Lung Cancer (Non Small Cell) |
January 1, 1998 |
Initial staging |
| Lung Cancer (Non Small Cell) |
July 1, 2001 |
Diagnosis, staging and restaging |
| Esophageal Cancer |
July 1, 2001 |
Diagnosis, staging and restaging |
| Colorectal Cancer |
July 1, 1999 |
Determining location of tumors if rising CEA level suggests recurrence |
| Colorectal Cancer |
July 1, 2001 |
Diagnosis, staging and restaging |
| Lymphoma |
July 1, 1999 |
Staging and restaging only when used as an alternative to Gallium scan |
| Lymphoma |
July 1, 2001 |
Diagnosis, staging and restaging |
| Melanoma |
July 1, 1999 |
Evaluating recurrence prior to surgery as an alternative to a Gallium
scan |
| Melanoma |
July 1, 2001 |
Diagnosis, staging and restaging; Non-covered for evaluating regional
nodes |
| Breast Cancer |
October 1, 2002 |
As an adjunct to standard imaging modalities for staging patients with distant metastasis or restaging patients with locoregional recurrence or metastasis; as an adjunct to standard imaging modalities for monitoring tumor response to treatment for women with locally advanced and metastatic breast cancer when a change in therapy is anticipated. |
| Head and Neck Cancers (excluding CNS and thyroid |
July 1, 2001 |
Diagnosis, staging and restaging |
| Thyroid Cancer |
October 1, 2003 |
Restaging of recurrent or residual thyroid cancers of follicular cell origin that have been previously treated by thyroidectomy and radioiodine ablation and have a serum thyroglobulin >10ng/ml and negative I-131 whole body scan performed |
| Myocardial Viability |
July 1, 2001 to
September 30, 2002 |
Covered only following inconclusive SPECT |
| Myocardial Viability |
October 1, 2002 |
Primary or initial diagnosis, or following an inconclusive SPECT prior to revascularization. SPECT may not be used following an inconclusive PET scan |
| Refractory Seizures |
July 1, 2001 |
Covered for pre-surgical evaluation only |
| Perfusion of the heart using Rubidium 82* tracer |
March 14, 1995 |
Covered for noninvasive imaging of the perfusion of the heart |
| Perfusion of the heart using ammonia N-13* tracer |
October 1, 2003 |
Covered for noninvasive imaging of the perfusion of the heart |
*Not FDG-PET.
Verantwortlich für den Inhalt dieser Seite: cgd - 01.10.2004 |
|
