P.E.T.Net plans network growth despite reimbursement uncertainty

Cyclotron developer forecasts shortage of FDG in future

In an effort to keep pace with growing demand for F-18 fluorodeoxyglucose (FDG), P.E.T.Net Pharmaceutical Services of Norcross, GA, plans to establish up to 33 more cyclotron sites throughout the country in the next three to five years, according to Gene McGrevin, chairman and CEO. Demand for P.E.T.Net's services should increase once Medicare reimbursement rates are published for FDG lung cancer imaging, an event that industry experts believe could occur in the next several months.

P.E.T.Net operates 12 positron manufacturing and distribution centers, three of which it owns and nine of which it manages, and will launch its next site in the Baltimore/Washington area by the end of the year. As its network expands, the company expects 70% of the sites to be new machines purchased from cyclotron developer CTI of Knoxville, TN, and 30% to be management contracts.

The development of coincidence detection has increased demand for FDG: Camera manufacturers forecast that at least half the replacement cameras sold this year will carry coincidence imaging capability, which should dramatically boost the FDG market, according to McGrevin. P.E.T.Net is trying to spur market demand through relationships with gamma camera companies, such as a nonexclusive joint marketing program with Elscint. The Israeli company will supply a set number of introductory doses of FDG to its gamma camera customers with high-energy imaging packages (SCAN 5/27/98).

The rapid growth of high-energy imaging may result in FDG demand outstripping supply in the next few years, according to McGrevin.

"Some people might laugh at this statement, but we see that in the not-too-distant future there will be a shortage of FDG," he said.

An FDG shortage might surprise industry watchers who have weathered the often difficult process of making the isotope, and therefore PET imaging, more accessible. P.E.T.Net was established in 1996 by radiopharmacy firm Syncor International of Woodland Hills, CA, which partnered with CTI to establish a 10-site cyclotron network designed to make access to FDG easier.

With distribution issues on their way to being solved, PET imaging's remaining obstacle has been reimbursement. Last January, the Health Care Financing Administration announced that it would reimburse Medicare carriers for the diagnosis and staging of lung cancer using FDG. It promised to evaluate other applications as well (SCAN 1/14/98). In the interim, carriers and providers have negotiated their own cost-to-charge ratio, according to Dr. Edward Coleman, director of nuclear medicine at Duke University in Durham, NC.

With payment rates ambiguous, the effect of the January announcement on PET scans has remained unclear, Coleman said. But last week, the uncertainty was resolved when HCFA announced a national reimbursement rate of $1980, coverage that includes dedicated PET scanners and coincidence detection systems.