title: Outcomes and costs of positron emission tomography: comparison of intravenous adenosine and intravenous dipyridamole.
abstract: The objective of this study was to compare the cost of intravenous adenosine and intravenous dipyridamole in positron emission tomography (PET) in patients with coronary artery disease. A retrospective, open-label, case-control, cost-effectiveness analysis was performed in the out-patient nuclear medicine department of a university hospital. Thirty-six patients underwent dipyridamole PET, and 72 matched patients underwent adenosine PET. A cost-effectiveness analysis was conducted using a direct cost accounting approach to estimate institutional costs. Key costs evaluated included acquisition cost, administration cost, monitoring cost, cost of management of side effects, and cost of follow-up care. The total cost of adenosine PET and dipyridamole PET was divided by their respective predictive accuracies to provide a total cost adjusted for efficacy. Adenosine increased heart rate and lowered systolic blood pressure to a significantly greater extent than dipyridamole. The number of patients experiencing adverse drug reactions was significantly greater for adenosine (82%) than for dipyridamole (67%), but the frequency of prolonged (> 5 minutes) and late-onset side effects was significantly greater for dipyridamole than for adenosine. The frequency of side effects requiring medical intervention was also significantly greater for dipyridamole (53%) than for adenosine (6%). Although adenosine had a significantly greater acquisition cost than dipyridamole, costs of monitoring, management of side effects, and follow-up care were significantly less for adenosine than for dipyridamole. As a result, the total cost of using dipyridamole is significantly greater ($928.00 per patient) than the total cost of using adenosine ($672.00 per patient). Based on these results, adenosine may be the drug of choice for pharmacologic vasodilation for PET.
authors.affiliation: Creighton University School of Medicine, Omaha, Nebraska, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Holmberg
authors.forename: S M
authors.initials: SM
authors.lastname: Mohiuddin
authors.forename: D E
authors.initials: DE
authors.lastname: Hilleman
authors.forename: B D
authors.initials: BD
authors.lastname: Lucas
authors.forename: E C
authors.initials: EC
authors.lastname: Wadibia
mesh_terms: D000241:Adenosine / Q000009:adverse effects / Q000191:economics* / Q000494:pharmacology; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D003327:Coronary Disease / Q000000981:diagnostic imaging; D003362:Cost-Benefit Analysis; D004176:Dipyridamole / Q000009:adverse effects / Q000191:economics* / Q000494:pharmacology; D017850:Economics, Pharmaceutical; D004562:Electrocardiography; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed / Q000191:economics*; D014665:Vasodilator Agents / Q000009:adverse effects / Q000191:economics* / Q000494:pharmacology
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole; D000241:Adenosine