Nuc med procedure volume plunges more than 10% in 2006

October 25, 2007

The imaging world is used to hearing about a steadily rising demand for its services. But that isn’t the case this time. And it may be a harbinger of problems yet to come.

The imaging world is used to hearing about a steadily rising demand for its services. But that isn't the case this time. And it may be a harbinger of problems yet to come.

In 2006, demand in the U.S. for nuclear medicine procedures done with gamma cameras dropped by more than 10%, according to IMV Medical Information Division. A senior IMV analyst believes demand will rebound this year, but not to the levels seen in 2005.

Two million fewer nuc med procedures were done in 2006 than the year before, 17.7 million versus 19.7 million, according to an IMV survey of 7320 hospital and nonhospital sites. The double-digit drop is the result of two million fewer patient visits over that period: 15.2 million visits in 2006 versus 17.7 million visits in 2005, according to IMV.

Demand appears to be picking up, however, as survey results tallied for the first half of 2007 indicate. IMV predicts 16.3 million visits this year, an improvement over last year but still shy of the 2005 number. A similar rebound is expected in the number of procedures. They should reach 19.2 million in 2007, which, like the number of patient visits, is better than 2006 but still lags behind 2005.

The drop in 2006 can be at least partly attributed to precertification requirements imposed by insurance companies, according to Lorna Young, IMV senior director for market research. These requirements have an uneven and unpredictable effect, she said, because they are administered ad hoc by different insurance companies applying different policies over different regions of the U.S. Typically, however, the insurers impose some protocol, as in requiring that less expensive tests, such as stress echo, be performed before SPECT.

This could spell problems for other modalities similarly affected by precertifications, she said. These problems have not yet shown up on the radar, but will in the future.

"Precertification requirements are being set for other imaging modalities, including CT angiography, MRA, and PET," she said.

The partial rebound seen in the first half of 2007 might be explained by actions administrators took to remedy those precertification requirements. This is good news for imaging vendors, who rely on increasing demand for modalities to drive the sale of new systems, as it means the problem can be addressed.

"Radiology administrators might be making sure precerts are done early enough or they might be taking the initiative to better manage patients," Young said.

The less-than-full rebound predicted in 2007, however, is reason for continuing concern. At play may be factors beyond administrators' control, she said, though there might be a silver lining for medical equipment makers. A leading possibility is that competing modalities are eating into nuclear medicine procedures.

The increasing use of PET/CT for oncology applications, for example, may be cutting into demand for bone scans using gamma cameras, Young said. Similarly, CT angiography and MR angiography may be taking some of the cardiac cases that otherwise would have been sent to nuc med. Such cannibalization would have a greater effect today than a few years ago, as the percentage of nuclear cardiac scans has grown from 54% of all nuc med exams in 2002 to 60% in 2006, according to IMV data.

Reduced procedure volume, particularly if it is transitory, is not expected to have much impact on the market for gamma cameras, which has been steadily edging downward for more than a decade, according to industry estimates. IMV survey data characterize the market for gamma cameras as heavily dependent on replacement sales, which account for more than three-quarters of the cameras purchased.

The average number of nuclear imaging cameras installed per site is 1.8 units, according to IMV. Dual-head SPECT cameras have been the preferred configuration dating back to the mid-1990s, according to reports in DI SCAN. Not surprisingly, such units account for more than two-thirds of the camera acquisitions being planned by sites surveyed by IMV.

The maturity of the nuclear medicine market is evident in its technology, which has hardly changed in more than 10 years. PET/CT is the only major advance to have come along in this period, and has been so successful that many analysts now separate it from the rest of nuclear medicine. A new development, however, may be on the way with SPECT/CT, which IMV analysts believe will make up more than 10% of the gamma cameras installed in the first half of 2007.

Another indicator of future potential growth is a rise in the number of sites with budgets of $250,000 or more over the last several years. In 1999, only 15% of the sites surveyed by IMV had budgets of this size. The most recent survey indicates 32% of sites now have such budgets.