Medicare Puts PET for Thyroid Cancer, Soft Tissue Sarcoma on Hold

WASHINGTON—An advisory group to the Centers for Medicare and Medicaid Services (CMS) has delayed a decision on whether to recommend Med-icare coverage for positron emission tomography (PET) with the radiopharmaceutical F-18-fluorodeoxyglucose (FDG) in the management of thyroid cancer and soft tissue sarcoma.

In both instances, the Medicare Coverage Advisory Committee (MCAC) concluded that "after an exhaustive review of available literature, we have been unable to make an evidence-based decision." CMS said it would delay any determination "until MCAC has reviewed and made recommendations on reviewing evidence for rare conditions."

In December 2000, CMS (then known as the Health Care Financing Administration) ruled there was insufficient evidence to support coverage of PET for managing thyroid cancer. Last year, the American Thyroid Association appealed that decision and submitted new medical data to support the use of PET in the disease. CMS sought an assessment of the data from the Agency for Healthcare Research and Quality (AHRQ), which, the MCAC decided, failed to find sufficient evidence to support coverage.

In its assessment, AHRQ stated: "FDG-PET may be helpful in tumor grading, but offers inadequate discrimination between low-grade tumors and benign lesions. There is insufficient data on the impact of FDG-PET on clinical outcomes and on the usefulness of FDG-PET in assessing the response to therapy."