Numbers of CT Scanners and Services
- By mid 1987 there were at least 170 CT units in Australia, 118 in the private sector and 52 in the public sector. Geographically there is some imbalance in their distribution, with some country regions lacking services.
- In 1986/87 Medicare payments for CT services totalled nearly $68 million. Taking into account public hospital costs and individual contributions, the total cost to Australia of CT services was in the region of $90 million.
- There has been very rapid growth in CT services since 1980/81.
- In 1986/87 medical benefits were paid for over 279,000 CT examinations, 7 times the number in 1980/81. These included examinations on patients referred from public hospitals to private practice.
- Preliminary Medicare data for the first half of 1987/88 suggest that growth in private sector CT services slowed during that period.
- CT has replaced a number of procedures which are less effective or more invasive, but the increase in the number of CT examinations since 1980/81 far exceeds any decline in the number of alternative non-surgical diagnostic procedures. Use of CT has also resulted in a reduction in exploratory surgery. The extent of this reduction is not known.
Safety and Efficacy of CT
- A large body of evidence exists for the efficacy and cost effectiveness of CT when appropriately applied.
- It would be inappropriate to use CT
- to rule out disease in cases where it is generally accepted that an adequate clinical examination would suffice;
- solely to insure against possible legal action;
- to provide information which could have no effect on patient management.
- There are small but real risks associated with CT examinations, related to the use of contrast media and ionising radiation. These need to be taken into account when CT examinations are proposed.
Place of CT in Australian Health Care
- There are several reasons for the rapid growth in CT examinations, including demonstrated diagnostic excellence, value in patient management, reimbursement policies, a broad referral basis, and policies on public sector CT procurement. The Panel notes the impact of different funding mechanisms on the distribution of this technology and access to it.
- CT will continue to be a major diagnostic modality in Australia for the foreseeable future. The Panel considers that competing technologies will have little effect on the numbers of CT services over the next 5 years.
- Lower cost CT scanners are now available. These have lower technical capability than the more expensive machines, but may be able to provide effective diagnostic coverage in many situations. Their role in health care services merits careful consideration by government and professional bodies.
- Little quantitative information is available on how CT is used in Australia or its effect on patient management.
- The Panel recommends that:
- In view of the high cost to Australia of this modality a study be undertaken to determine its contribution to patient care and the extent of cost savings achieved through its use. This would require the collection of detailed, quantitative information from a sample of CT units on the indications for which patients are referred, sources of referral, the results of examinations, and their contribution to diagnosis and management decisions.
- Professional bodies, including the Royal Australasian College of Radiologists, the Royal Australasian College of Physicians, the Royal Australasian College of Surgeons and the Royal Australian College of General Practitioners, consider the development of guidelines for referring medical practitioners on the use of CT. Such guidelines should include advice on appropriate indications for CT examination, risks, costs and expected benefits.
- The Panel would also support publication of data on CT from Australian sources as an aid to education of users of the technology.