Appropriate Use of FDG-PET for the Management of Cancer Patients

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In the past decade, appropriateness has become a guiding principle to justify the introduction of new health care interventions, from the use of new drugs or new treatment modalities to the implementation of new diagnostic procedures. The concept of appropriateness, with a decision aid for its assessment, provides clinicians and funders with a tool to determine which diagnostic investigations and therapies should be implemented. In the context of diagnostic investigations, new investigations are deemed appropriate when the difference between the expected incremental information and the expected or possible adverse effects is sufficiently large that the investigation is warranted for the indication concerned. The decision tool for rating appropriateness includes a literature review and synthesis of the evidence according to designated indications.

Although the concept of appropriateness has been defined in terms of clinical utility, it may also be used to assist in the allocation of limited resources in an environment of shrinking health budgets. There is, however, the danger that new interventions will be underutilized, because they are viewed by health care administrators as inappropriate. This could be due to a narrow interpretation of appropriateness that is based solely on the cost of the intervention, isolated from the potential cost savings derived from its use. In reality, therefore, there might be a series of interventions, services and health services of proven effectiveness that are widely underutilized, whose necessary implementation requires, at least in the short and medium terms, an increase in costs.

Funding decision makers must accept that the main aim of appropriateness is not cost reduction, but rather optimization of health resource allocation, recognizing the consequences of failure to implement innovations of proven effectiveness. It is only through acceptance of this perspective that innovations of proven effectiveness will be introduced for the benefit of both individuals and society.

The purpose of this publication is to develop a consensus based on evidence from existing systematic reviews, to make health care providers aware of the value and the appropriateness of the introduction of positron emission tomography (PET) or PET combined with computed tomography (PET/CT) using 2-fluoro-2-deoxy-D-glucose (FDG) labelled with 18F in the management of patients affected by cancer.