Public and private financing bring PET/CT to patients in Hungary

The arrival of PET/CT has shaken up the market for oncology imaging in economically advanced nations, but this technology has had minimal impact on financially strapped countries. PET/CT is expensive, stretching budgets of even the well off and looming beyond the reach of those less fortunate. This is especially true for hospitals in Central and Eastern Europe that are seeking to modernize healthcare services.

The opening in May of a PET/CT center in Budapest illustrates one way state-of-the-art imaging services can be introduced under such conditions.

The new PET/CT system, housed at the National Scientific Institute of Neurosurgery, is the first to reach Hungary and southeastern Europe. Its purchase was made possible through collaboration between state healthcare providers and private investors. Together, they raised around a billion Hungarian forints (US$5 million) for a dedicated PET/CT center. The monies were used to fund a new wing for the nuclear medicine department at the neurosurgery institute and a Discovery ST system from GE Healthcare.

"The idea came initially from doctors at the hospital, who saw a need for their patients, but lacked the financing for such a big project," said Gzim Ademaj, regional manager for Eastern Europe with GE Healthcare. "It took two to three years to get from this initial stage to where we are today."

Prior to the installation, Hungary's PET needs were met by a single 10-year-old PET camera capable of performing 700 to 800 examinations a year. The Discovery ST will be expected to scan 12,000 patients in the same period.

Hungarians seeking a PET/CT scan will have to pay for the examination out of their own pockets, however. They may also find themselves sharing the facility with Slovenians, Ukrainians, and Croatians, given that the center is welcoming fee-paying patients from neighboring countries who have no other access to PET/CT.

The Budapest PET/CT center is not the first instance in Hungary of private investors helping public hospitals provide diagnostic imaging services. Nor is it likely to be the last instance of shared public-private investment in imaging facilities, either in Hungary or the surrounding region, though the notion of profiting from healthcare provision remains uncommon in the former communist countries.

"Without these initiatives, it will not be possible to provide this high-cost technology in such countries, because the healthcare system is not at a stage where they can finance such an investment with public funds," Ademaj said.

The demand for high-end medical imaging equipment in Central and southeastern Europe is greater than many people might imagine, Ademaj said. GE Healthcare estimates that around 30 MR scanners and 80 CT units are up and running in Hungarian hospitals and clinics, which serve a population of 10 million.

"Patients in Hungary have the right to get the same healthcare treatment that has been provided for the past five or six years in other European countries," he said.

Access to PET/CT is increasing rapidly in Western Europe. GE Healthcare has sold more than 80 Discovery PET/CT systems to European customers to date. The majority of these sales have been in Italy and France.

One key factor that has affected Europe-wide expansion of PET is limited access to radiopharmaceuticals. The short half-life of radioisotopes used in diagnostic imaging means that modalities must be sited relatively close to a cyclotron. Hospitals out of reach of a radiotracer supply, consequently, must consider funding a cyclotron themselves.

Doctors working at the Budapest PET/CT center will be sourcing FDG from an existing nearby cyclotron, said Trung Nguyen, PET/CT product manager for GE Healthcare. Construction of an onsite cyclotron is being considered.

While the additional investment required could, in theory, be recouped in FDG sales to other facilities, doctors at the center are more concerned with the potential clinical benefits, he said.

"The main interest in having the cyclotron is to have access to other radiopharmaceuticals that cannot be distributed, such as carbon-11 choline," he said. "This tracer would have a much wider application for prostate cancer, which cannot be addressed with FDG."