The ICES report (2001) has served as the foundation for all PET policies in Ontario, yet questions about the validity of the assessment tools used in the report persist a full decade after its findings were submitted. At the core of the issue are questions about the appropriateness of the health technology assessment (HTA) system used by the government in evaluating a diagnostic imaging tool such as PET.
This question was raised in the Journal of Nuclear Medicine by prominent Canadian nuclear medicine physician Dr. Sandy McEwan (McEwan, 2005). Using the Ontario situation as an example, McEwan stated “… HTA is a policy tool, often used to justify negative funding decisions, rather than a rigorous scientific methodology ... HTA algorithms have been assigned to assess the evaluation and efficacy of new drugs and medical interventions ... they are totally unsuited to the evaluation of the clinical importance of imaging tests.”
McEwan points out that one key outcome assessed by HTA is the survival benefit conferred by an imaging test, even though imaging tests are not designed to improve survival but to direct treatment planning and ensure that the best strategy is followed for the patient’s condition. Conversely, the HTA ignores the important role of imaging in “treatment planning and assessment of response, the reductions in downstream costs such as saved operations due to upstaging, and the contribution of imaging to diagnostic confidence.” Until these endpoints are incorporated in the HTA, McEwan – and, indeed, much of the nuclear medicine community in Ontario – believes that the results of the HTA of imaging modalities “will remain arbitrary and capricious."