title: ¹⁸F-FDG PET/CT in inflammation of unknown origin: a cost-effectiveness pilot-study.
abstract: OBJECTIVE
  Patients with increased inflammatory parameters, nonspecific signs and symptoms without fever and without a diagnosis after a variety of diagnostic procedures are a diagnostic dilemma and are referred to as having inflammation of unknown origin (IUO). The objective of this pilot study was to compare the cost-effectiveness of a diagnostic work-up/strategy with and without (18)F-FDG PET/CT in patients with IUO using a published dataset as a reference.
  
  
  METHODS
  IUO patients without (18)F-FDG PET/CT (group A, 46 patients) and IUO patients referred for (18)F-FDG PET/CT (group B, 46 patients) were selected. IUO was defined as the combination of nonspecific signs and symptoms and a prolonged erythrocyte sedimentation rate (ESR), defined as ≥age/2 in men and ≥(age + 10)/2 in women (ESR in millimetres per hour and age in years), and/or C-reactive protein (CRP) ≥15 mg/l. The costs of all tests and procedures and the number of hospitalization days in each patient to reach a diagnosis were calculated using current Dutch tariffs.
  
  
  RESULTS
  In group A a diagnosis was reached in 14 of the 46 patients. The mean cost per patient of all the diagnostic procedures was <euro>2,051, and including the cost of hospitalization was <euro>12,614. In group B a diagnosis was reached in 32 of the 46 patients. The mean cost per patient of all the diagnostic procedures was <euro>1,821, significantly lower than in group A (p < 0.0002), and including the cost of hospitalization was <euro>5,298.
  
  
  CONCLUSIONS
  In IUO (18)F-FDG PET/CT has the potential to become a cost-effective routine imaging technique indicating the direction for further diagnostic decisions thereby allowing unnecessary, invasive and expensive diagnostic investigations to be avoided and possibly the duration of hospitalization to be reduced. However, a prospective multicentre "bottom-up microcosting" cost-effectiveness study is warranted before these preliminary data can be extrapolated to clinical practice.
authors: Department of Nuclear Medicine, Medical Center Leeuwarden, P.O. Box 850, 8901 BR, Leeuwarden, The Netherlands, hans.balink@znb.nl.
authors: H
authors: H
authors: Balink
authors: S S
authors: SS
authors: Tan
authors: N J G M
authors: NJ
authors: Veeger
authors: F
authors: F
authors: Holleman
authors: B L F
authors: BL
authors: van Eck-Smit
authors: R J
authors: RJ
authors: Bennink
authors: H J
authors: HJ
authors: Verberne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D005335:Fever of Unknown Origin / Q000000981:diagnostic imaging*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000191:economics*; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics*; D055815:Young Adult
chemical_list: D019788:Fluorodeoxyglucose F18
references: Clin Dev Immunol. 2013;2013:623036
references: 24027590
references: Eur J Nucl Med Mol Imaging. 2010 Jan;37(1):136-45
references: 19526234
references: Nature. 2008 Jul 24;454(7203):428-35
references: 18650913
references: Obstet Gynecol Clin North Am. 2012 Jun;39(2):145-63
references: 22640708
references: Rev Esp Med Nucl Imagen Mol. 2012 Jul-Aug;31(4):178-86
references: 23067686
references: Med Educ. 2011 Aug;45(8):827-34
references: 21752079
references: Eur J Health Econ. 2009 Feb;10(1):39-45
references: 18340472
references: Clin Nucl Med. 2014 May;39(5):419-25
references: 24662652
references: Nature. 2006 Dec 14;444(7121):875-80
references: 17167476
references: Eur J Intern Med. 2009 Jul;20(4):415-8
references: 19524186
references: Arch Intern Med. 2009 Nov 23;169(21):2018-23
references: 19933965
references: JAMA. 1999 Dec 8;282(22):2131-5
references: 10591334
references: Medicine (Baltimore). 2007 Jan;86(1):26-38
references: 17220753
references: Eur J Health Econ. 2005 Mar;6(1):38-44
references: 15772871
references: Med Care. 1999 Apr;37(4 Suppl Va):AS3-8
references: 10217379
references: Int J Technol Assess Health Care. 2012 Apr;28(2):152-8
references: 22559757
references: Rev Med Interne. 2002 Aug;23(8):683-9
references: 12360749
references: PLoS One. 2013;8(3):e58917
references: 23527049
references: Clin Nucl Med. 2009 Dec;34(12):862-8
references: 20139818
references: Clin Rheumatol. 2012 May;31(5):861-71
references: 22322206