[Analysis of cost-effectiveness in the diagnosis of fever of unknown origin and the role of (18)F-FDG PET-CT: a proposal of diagnostic algorithm].
OBJECTIVE
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.


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 (18)F-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.


CONCLUSIONS
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.
Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, España. mitsurobn@hotmail.com
E M
EM
Becerra Nakayo
A M
AM
García Vicente
A M
AM
Soriano Castrejón
J A
JA
Mendoza Narváez
M P
MP
Talavera Rubio
V M
VM
Poblete García
J M
JM
Cordero García
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001774:Blood Chemical Analysis / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics / Q000209:etiology; D005462:Fluorine Radioisotopes / Q000191:economics; D019788:Fluorodeoxyglucose F18 / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000191:economics*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000191:economics; D012189:Retrospective Studies; D012698:Serologic Tests / Q000191:economics / Q000706:statistics & numerical data; D013030:Spain; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures / Q000191:economics; D055815:Young Adult
D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18