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Cardiac PET Market

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by

Howard Lewin

on 23 September 2014

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Transcript of Cardiac PET Market

Cardiac PET Market
Why am I here?
PET vs SPECT
Variable Indications
Cardiology/Nuclear Medicine
Trained/Worked CSMC
Business Owner
Cardiac Imaging Assoc
Positron Imaging Partners
ASNC BoD
CCCVI founding BoD/Treasurer
Howard C. Lewin, MD FASNC FACC
PET vs SPECT
Enhanced Sens/Spec
Pronostic Value
Short exam time
Significantly lower exposure
Attenuation Correction
Good Sens/Spec
Ubiquitous
Robust prognostic value
Lower Radiation Exposure
Shorter imaging time
Superior Sensitivity/Specificity
Small hearts
Better spatial resolution
Less partial volume effect and better defect detection in small ventricles
Lower False Positive Rate
Broad indications
*
Reimbursement
*
Why Cardiac PET
From http://asnc.org/imageuploads/RadiationReduction060110.pdf
ASNC Radiation Exposure Reduction
Lower Radiation Exposure
Shorter imaging time
SPECT 120 to 240 minutes
Average PET ~ 45 minutes or less
Why Cardiac PET
Confirm position of Rest-Rb82 scan
Confirm position of Rest-Tx scan
Lexiscan
Injection
Rb82 Stress
Injection
Rb82 Rest
Injection
2 minutes
1 minute
5 minutes
5 minutes
2 minutes
1.5 minutes*
2 minutes
Rest Tx† Rest Gated PET Stress Gated PET
* - 90 second post-injection delay for LVEF > 40%, 120 seconds for LVEF < 40%
† - rest transmission scan applied to both rest and stress perfusion images
PIP Optimized Rb82 Protocol
Scan Time < 30 minutes
Camera
New PET/CT systems are > $1m
CT not needed for Cardiac PET
Dedicated PET (Ge68 transmission AC) adequate for cardiac applications
No change of bed position required - less misregistration
Should have List-Mode for Quant MBF
Structural Support may be required
Shielding
More significant for FDG; Rb82 requirements not onerous
Space requirements
Isotope
Significant front-end commitment (~$500K/year)
Cardiac PET - Obstacles
1 minute
2 minutes*
5 minutes
DraxImage
Radiopharmecuetical experience
Owns Process
21st Century delivery platform
Superior Product?
DraxImage
Bracco
The Future for SPECT vs PET
Like ETT and Stress Echo, SPECT will survive
Growth for PET in large healthcare systems
Economy of scale
Availability
Sens/Spec
Radiation
Medium to Large private practice groups
LCD
Reimbursement
Private insurance adoption
Impact of ACO???
Recipe for Success
If I had this I would be on the other side of the table

Learn from the mistakes of others
Promote the work needed to garner support of payers
Downstream affect of PET vs SPECT
outcomes
COST!
Radiation
Patient Satisfaction
Innovate
Unit dose tracer
Flurpiridaz not perfect
exposure to staff
significant cost
Ischemia imaging
KOLs
Dorbola
DiCarli
Bateman
Beanlands
DeKemp
Madahhi
Dilsizian
Advances
Prognosis
DIRECT SPECT vs PET (real world)

Quantitation
Novel Tracers
Flurpiridaz
A9555 Reimbursement
Varies between MACs
Acquistion Cost vs Fixed Price
Fixed Price Range
$250 - $
1751.27
per dose
SPECT
PET
Economically "easy"
Economically challenging
July 25, 2011
through
February 14, 2012 +
NO Income for >7 months

Ongoing Supply Issues
The Recall...
Significant financial loss
&
Uncertainty and Instability
Referring Physician
Physician/Business Owner
Perspective

+
Loss of one supplier of Sr
+
Regulatory cancellation of generators
+
some sites just getting product back now!
Grow at a pace you can handle
Plan for supply chain issues
Sr-supply seems to be a challenge
Communicate with ASNC/Customers
Don't act like 'the only game in town'
Medicare
Private (non-Medicare)
Referrals to Cardiac PET by Payer
Obesity
Inconclusive SPECT

Preauthorization
Tremendous regional (MAC) variation
LCDs vary from
Same as SPECT to
No NCD
ASNC to publish Model LCD
Full transcript