title: IntegoTM infusion system: cost effectiveness analysis focusing on dosimetry, sterility and management.
abstract: BACKGROUND
  Healthcare providers across Europe are facing an ever-growing demand in clinical PET referrals. Currently, it is estimated that the administration of the PET tracer accounts for approximately 40% of the unitary PET procedure reimbursement (uPETr). Although the cost of PET/CT is highly dependent on the radiopharmaceutical cost itself, little is known about the economic impact of the utilized administration method and the repercussions on staff radiation exposure. Our objective was to evaluate the cost-effectiveness of automatic injection/fractionation system Intego™ (Bayer HealthCare, MEDRAD Europe, Netherlands) for istaff radiation exposure reduction and to validate its use with 18F-choline (FCH).
  
  
  METHODS
  In order to validate Intego™ use with FCH we analyzed sterility, radioactivity fractionation accuracy and radiation protection for staff. We analyzed Intego™ impact on examination costs and its impact on organization efficiency. A cost-effectiveness analysis (CEA) was estimated as the incremental cost to reduce staff radiationexposure.
  
  
  RESULTS
  According to our data, Intego™ ensures both sterility and accuracy of FCH doses' activity, reducing, at the same time, the exposure to radiation either whole body and at the extremities (94% and 75% respectively for the technicians and complete reduction for physicians). Intego™'s variable unit costs are higher than the SA (respectively 1.8% and 0.4% of PET reimbursement), while staff costs are significantly higher with SA (respectively 0.27% and 1.57% of unitary PET reimbursement [uPETr]). In our simulation, based on a 2,450 PET yearly output, the differential costs were slightly higher by using Intego™™ (+ 14%). The incremental cost-effectiveness ratio (ICER) was equal to 1.1, i.e. the healthcare provider pays an additional cost of 0.38% of uPETr to obtain a significant reduction of staff radiation exposure (-4.5 µS).
  
  
  CONCLUSIONS
  Intego™, for its favorable results in terms of cost effectiveness, could be a useful tool in a nuclear medicine department, limiting the staff radiation exposure.
authors.affiliation: Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy - federica.matteucci@irst.emr.it.
authors.forename: Federica
authors.initials: F
authors.lastname: Matteucci
authors.affiliation: Planning and Control Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Solinas
authors.affiliation: Health Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Turri
authors.affiliation: Pharmacy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Donati
authors.affiliation: Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: D'errico
authors.affiliation: Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Moretti
authors.affiliation: Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy.
authors.forename: David
authors.initials: D
authors.lastname: Bianchini
authors.affiliation: Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Paganelli
authors.affiliation: Planning and Control Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Gallegati
authors.affiliation: Health Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Forlì-Cesena, Italy.
authors.forename: Mattia
authors.initials: M
authors.lastname: Altini
mesh_terms: D002794:Choline / Q000008:administration & dosage / Q000031:analogs & derivatives; D003362:Cost-Benefit Analysis; D007267:Injections; D049268:Positron-Emission Tomography / Q000009:adverse effects* / Q000191:economics*; D000069079:Radiation Exposure / Q000517:prevention & control; D011874:Radiometry
chemical_list: C514960:fluorocholine; D002794:Choline