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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Analysis of cost-effectiveness in the diagnosis of fever of unknown origin and t...
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Vol. 31. Issue 4.
Pages 178-186 (July - August 2012)
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Vol. 31. Issue 4.
Pages 178-186 (July - August 2012)
Original article
DOI: 10.1016/j.remnie.2011.08.001
Analysis of cost-effectiveness in the diagnosis of fever of unknown origin and the role of 18F-FDG PET–CT: A proposal of diagnostic algorithm
Análisis de costo-efectividad en el diagnóstico de fiebre de origen desconocido y el papel de la 18F-FDG PET-TC: propuesta de algoritmo diagnóstico
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E.M. Becerra Nakayo
Corresponding author
mitsurobn@hotmail.com

Corresponding author.
, A.M. García Vicente, A.M. Soriano Castrejón, J.A. Mendoza Narváez, M.P. Talavera Rubio, V.M. Poblete García, J.M. Cordero García
Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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Tables (5)
Table 1. Complementary tests according to the diagnostic phase of the FUO process.
Table 2. Real and theoretical costs in euros (€) of the FUO process before PET–CT. The theoretical cost of hospitalization was determined as the mean of the range of the three diagnostic phases.
Table 3. Real and theoretical costs in euros (€) of the complementary tests for each diagnostic phase according to the different guidelines of patient management. Costs obtained for the product of the unit cost of each test and the number of test requested in theory and in real practice. The real cost also included an section of “other tests” not included in the diagnostic guidelines.
Table 4. Proposed cost-effectiveness, evaluating the theoretical costs of the inclusion of PET–CT in the second diagnostic phase of the FUO process including days of hospitalization, outpatient consultation and complementary tests.
Table 5. Review of the literature regarding the role of PET/PET–CT FDG in fever of unknown origin (FUO).
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Abstract
Aim

To analyze the costs of fever of unknown origin (FUO) prior to the PET–CT study. To determine the effectiveness of PET–CT in the diagnosis of FUO. A proposal of diagnostic algorithm.

Material and methods

A retrospective study was performed that included 20 patients who had been studied between January 2007 and January 2011, with a mean age of 57.75 years and FUO diagnosis. All underwent a PET–CT study with 18F-FDG.

Individual and mean costs of FUO in these patients were assessed, including hospitalization days and complementary tests prior to the PET–CT study.

The effectiveness of the PET–CT study in the diagnosis of FUO was analyzed. Costs of the FUO process were determined, including those of the PET–CT study, and if it had been done earlier in the diagnostic process.

Results

Mean hospital stay per patient until the PET–CT study was 28 days. The cost per hospitalization day was 342 €. Average cost per patient in complementary tests was 1395 €. Total cost of the FUO process until the PET–CT study was around 11167 € per patient.

The PET–CT study showed a 78% sensitivity, 83% specificity, 92% PPV and 62% NPV.

If PET–CT had been performed earlier in the FUO process, assuming the same effectiveness, 5471 € per patient would have been saved.

Conclusion

The PET–CT study could be cost-effective in the FUO process if used at an early stage, helping to establish an early diagnosis, reducing hospitalization days due to diagnostic purposes and the repetition of unnecessary tests.

Keywords:
Fever of unknown origin
PET–CT
18F-FDG
Cost-effectiveness
Resumen
Objetivo

Analizar los costes previos a la PET-TC del proceso fiebre de origen desconocido (FOD). Determinar la efectividad de la PET-TC en el diagnóstico de FOD. Propuesta de algoritmo diagnóstico.

Material y métodos

Se realizó un estudio retrospectivo, que incluyó a 20 pacientes estudiados entre enero de 2007 y enero de 2011, con diagnóstico de FOD y con una edad media de 57,75 años. A todos los pacientes se les realizó un estudio PET-TC con 18F-FDG.

Se analizaron los costes individuales y las medias que representó el proceso FOD de estos pacientes, incluyendo días de hospitalización y pruebas complementarias previas a la PET-TC.

Se valoró la efectividad de la PET-TC en el diagnóstico de FOD. Se determinaron los costes del proceso FOD, incluyendo el de la PET-TC y si ésta se hubiera realizado de forma precoz.

Resultados

La estancia media hospitalaria por paciente hasta la PET-TC fue de 28 días. El coste por día de hospitalización fue de 342 €. El coste promedio por paciente en pruebas complementarias fue de 1.395 €. El coste total del proceso FOD hasta la PET-TC fue de 11.167 € por paciente.

La PET-TC mostró una sensibilidad del 78%, una especificidad del 83%, un VPP del 92% y un VPN del 62%.

Si la PET-TC se hubiera realizado antes en el proceso FOD, asumiendo la misma efectividad, se hubieran ahorrado 5.471 € en cada paciente.

Conclusiones

La PET-TC pudiera ser costo-efectiva en el proceso FOD si se empleara de forma precoz, porque ayudaría a establecer un diagnóstico temprano, reduciendo los días de hospitalización por motivos de estudio y la repetición de pruebas innecesarias.

Palabras clave:
Fiebre de origen desconocido
PET-TC
18F-FDG
Costo-efectividad

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