Willingness to pay for PET cancer screening

Presenter: Chisato Hamashima, National Cancer Center

Abstract

Backgrounds: Due to the interest in early cancer detection in Japan, whole body positron emission tomography (PET) screening for cancer has disseminated rapidly. PET scanners including PET-CT are present not only in hospital but also in diagnostic imaging centers next to certain hotel resort facilities that offer package tours. A few clinics have reported high detection rates, but the efficacy of PET screening has not yet been established by reliable studies. Therefore, cancer screening guidelines have not evaluated PET screening due to the lack of reliable studies.
Methods: We investigated the charges put on PET screening based on the list of the PET Promoting Association published in 2006. In 2006, 141 clinics or hospitals perform PET examinations using 18 FDG to detect cancer. We limited our investigation to screening and excluded diagnostic testing. In November 2006, we conducted an Internet survey dealing with willingness to pay (WTP) for PET cancer screening. The questionnaire was open-ended without any information concerning PET screening provided.
Results: 1) PET screening charge: Of the clinics listed, 47 clinics showed their PET screening charges on their web-site; the charge ranged from $583.3 (70,000 yen) to $1050.0 (120,000 yen). The mode ranged $666.7 (80,000 yen) to $750.0 (90,000 yen).
2) Internet survey: One hundred five males and 219 females participated in the internet survey. The WTP was different between age group in males and females. In the 20 to 49 years age group, the mode ranged from $83 (10,000 yen) to $167 (20,000 yen). On other hand, in the over 50 year’s age group the mode ranged from $417 (50,000 yen) to $500 (60,000 yen).
Discussion: In Japan, public is enthusiastic about being able to diagnose a cancer that is unlikely to cause any problems in their lifetime. However, most people were skeptical about PET cancer screening; their WTP were less than the current charge for staging diagnosis supported by health care insurance. Although PET is useful for diagnosis and monitoring of cancer, its efficacy of cancer screening is unclear. Before the promotion of PET screening, its efficacy needs to be evaluated by a reliable study. Meanwhile, we have to balance the benefits and the harms of PET screening. If there is a request from a patient, a health care professional should give appropriate information and support their decision making.
Conclusions: Most people were skeptical about PET cancer screening and were their WTP less than the current charge made for PET screening.