Doing more harm than good? Do systematic reviews of PET by health technology assessment agencies provide an appraisal of the evidence that is closer to the truth than the primary data supporting its use?

Health technology assessment (HTA) has the objective of providing individual patients, clinicians, and funding bodies with the highest-quality information on the net patient benefits and cost effectiveness of medical interventions. Founded on systematic reviews of the available evidence, HTA aims to reduce bias and thereby provide a more valid evaluation of the benefits of new medical interventions than the primary studies themselves. Competing with the traditional role of medical experts, HTA agencies have gained considerable influence over public opinion and policy. The fundamental tenets of evidence-based medicine mandate that this influence should be used first and foremost for the benefit of patients. Over nearly 2 decades, multiple HTA systematic reviews in many countries have discredited most or all of the evidence pertaining to the ability of PET to improve patient-important outcomes. These determinations have delayed, restricted, and, in many cases, prevented access to this technology, especially by cancer patients. HTA systematic review findings are very much at variance with the opinion of clinicians. Our scrutiny of these reviews, benchmarking them against the core values of science and evidence-based medicine, has revealed errors of fact, inappropriate exclusion of pertinent data, and injudicious appraisal of the clinical relevance of evidence, potentially introducing bias into these reviews and compromising the validity of their conclusions about the net patient benefits of PET. We believe that our findings mandate that the molecular imaging community actively engage institutionalized HTA agencies to ensure appropriate representation of our primary data and adherence to the highest principles of evidence-based medicine.