FDG-PET/CT for investigation of pyrexia of unknown origin: a cost of illness analysis.

Publisher: Springer-Verlag Berlin Country of Publication: Germany NLM ID: 101140988 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1619-7089 (Electronic) Linking ISSN: 16197070 NLM ISO Abbreviation: Eur J Nucl Med Mol Imaging Subsets: MEDLINE

Original Publication: Berlin : Springer-Verlag Berlin, 2002-

Positron Emission Tomography Computed Tomography* ; Fever of Unknown Origin*/diagnostic imaging; Humans ; Fluorodeoxyglucose F18 ; Retrospective Studies ; Positron-Emission Tomography/methods ; Cost of Illness ; Radiopharmaceuticals

Background: Our study aims to explore the current utilisation of ¹⁸ F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the diagnostic pathway of pyrexia of unknown origin (PUO) and associated cost of illness in a large tertiary teaching hospital in Australia.
Method: 1257 febrile patients between June 2016 and September 2022 were retrospectively reviewed. There were 57 patients who met the inclusion criteria of "classical PUO", of which FDG-PET/CT was performed in 31 inpatients, 15 outpatients and 11 inpatients did not have an FDG-PET/CT scan. The patient demographics, clinical characteristics and inpatient cost were analysed, together with the diagnostic performance of FDG-PET/CT and impact on clinical management.
Result: The mean age, length of stay and total cost of admission were higher for inpatients who received FDG-PET/CT versus those who did not. The median cost per patient-bed-day did not differ between the two groups. Inpatients who received earlier FDG-PET/CTs (≤ 7 days from admission) had shorter length of stays and lower total cost compared to those who received a later scan. A negative FDG-PET/CT scan, demonstrating no serious or life-threatening abnormalities resulted in subsequent discharge from hospital or outpatient clinic in 7/10 (70%) patients. There were 11/40 (28%) scans where ancillary abnormalities were identified, requiring further evaluation.
Conclusion: FDG-PET/CT showed high diagnostic accuracy and significant impact on patient management in patients with PUO. FDG-PET/CT performed earlier in admission for PUO was associated with shorter length of stay and lower total cost.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Bharucha T, Rutherford A, Skeoch S, Alavi A, Brown M, Galloway J. Diagnostic yield of FDG-PET/CT in Fever of unknown origin: a systematic review, meta-analysis, and Delphi exercise. Clin Radiol. 2017;72:764–71. https://doi.org/10.1016/j.crad.2017.04.014 . (PMID: 10.1016/j.crad.2017.04.01428600002)
Schönau V, Vogel K, Englbrecht M, Wacker J, Schmidt D, Manger B, et al. The value of (18)F-FDG-PET/CT in identifying the cause of Fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study. Ann Rheum Dis. 2018;77:70–7. https://doi.org/10.1136/annrheumdis-2017-211687 . (PMID: 10.1136/annrheumdis-2017-21168728928271)
Wright WF, Auwaerter PG. Fever and Fever of unknown origin: review, recent advances, and lingering Dogma. Open Forum Infectious Diseases. 2020;7:ofaa132. https://doi.org/10.1093/ofid/ofaa132 . (PMID: 10.1093/ofid/ofaa132324620437237822)
Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Med (Baltim). 1961;40:1–30. https://doi.org/10.1097/00005792-196102000-00001 . (PMID: 10.1097/00005792-196102000-00001)
Mulders-Manders C, Simon A, Bleeker-Rovers C. Fever of unknown origin. Clin Med. 2015;15:280. https://doi.org/10.7861/clinmedicine.15-3-280 . (PMID: 10.7861/clinmedicine.15-3-280)
Bleeker-Rovers CP, Vos FJ, de Kleijn E, Mudde AH, Dofferhoff TSM, Richter C, et al. A prospective multicenter study on Fever of unknown origin: the yield of a structured diagnostic protocol. Med (Baltim). 2007;86:26–38. https://doi.org/10.1097/MD.0b013e31802fe858 . (PMID: 10.1097/MD.0b013e31802fe858)
Li Y, Wang Q, Wang X, Li X, Wu H, Wang Q, et al. Expert Consensus on clinical application of FDG PET/CT in Infection and inflammation. Ann Nucl Med. 2020;34:369–76. https://doi.org/10.1007/s12149-020-01449-8 . (PMID: 10.1007/s12149-020-01449-832086761)
Minamimoto R. Optimal use of the FDG-PET/CT in the diagnostic process of Fever of unknown origin (FUO): a comprehensive review. Jpn J Radiol. 2022;40:1121–37. https://doi.org/10.1007/s11604-022-01306-w . (PMID: 10.1007/s11604-022-01306-w357811779616755)
Chen J, Wang Q. Cost-effectiveness analysis of 18F-FDG PET/CT in the diagnosis of Fever of unknown origin in China. J Nucl Med. 2019;60:1063.
Chen JC, Wang Q, Li Y, Zhao YY, Gao P, Qiu LH, et al. Current situation and cost-effectiveness of (18)F-FDG PET/CT for the diagnosis of Fever of unknown origin and inflammation of unknown origin: a single-center, large-sample study from China. Eur J Radiol. 2022;148:110184. https://doi.org/10.1016/j.ejrad.2022.110184 . (PMID: 10.1016/j.ejrad.2022.11018435121332)
Balink H, Tan SS, Veeger NJ, Holleman F, van Eck-Smit BL, Bennink RJ, et al. ¹⁸ F-FDG PET/CT in inflammation of unknown origin: a cost-effectiveness pilot-study. Eur J Nucl Med Mol Imaging. 2015;42:1408–13. https://doi.org/10.1007/s00259-015-3010-0 . (PMID: 10.1007/s00259-015-3010-025655485)
Becerra Nakayo EM, García Vicente AM, Soriano Castrejón AM, Mendoza Narváez JA, Talavera Rubio MP, Poblete García VM, et al. [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]. Rev Esp Med Nucl Imagen Mol. 2012;31:178–86. https://doi.org/10.1016/j.remn.2011.08.007 . (PMID: 10.1016/j.remn.2011.08.00723067686)
Premathilaka R, Darshana T, Ekanayake C, Chathurangani KC, Mendis I, Perinparajah S, et al. Pyrexia of unknown origin (PUO) and the cost of care in a tertiary care institute in Sri Lanka. BMC Health Serv Res. 2023;23:177. https://doi.org/10.1186/s12913-023-09169-1 . (PMID: 10.1186/s12913-023-09169-1368100459945736)
Durack DT, Street AC. Fever of unknown origin–reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35–51. (PMID: 1651090)
Department of Health. Deriving Cost Buckets Victorian Cost Data Collection. In: Services, DoHaH, editors Victoria: Department of Health and Human Services; 2019.
Takeuchi M, Dahabreh IJ, Nihashi T, Iwata M, Varghese GM, Terasawa T. Nuclear Imaging for Classic Fever of unknown origin: Meta-Analysis. J Nucl Med. 2016;57:1913. https://doi.org/10.2967/jnumed.116.174391 . (PMID: 10.2967/jnumed.116.17439127339873)
Kan Y, Wang W, Liu J, Yang J, Wang Z. Contribution of 18F-FDG PET/CT in a case-mix of Fever of unknown origin and inflammation of unknown origin: a meta-analysis. Acta Radiol. 2019;60:716–25. https://doi.org/10.1177/0284185118799512 . (PMID: 10.1177/028418511879951230205705)
Ly KH, Costedoat-Chalumeau N, Liozon E, Dumonteil S, Ducroix JP, Sailler L, et al. Diagnostic value of 18F-FDG PET/CT vs. chest-abdomen-pelvis CT scan in management of patients with Fever of unknown origin, inflammation of unknown origin or episodic Fever of unknown origin: a comparative Multicentre prospective study. J Clin Med. 2022;11. https://doi.org/10.3390/jcm11020386 .
Wang WX, Cheng ZT, Zhu JL, Xing MY, Zheng CF, Wang SJ, et al. Combined clinical parameters improve the diagnostic efficacy of (18)F-FDG PET/CT in patients with Fever of unknown origin (FUO) and inflammation of unknown origin (IUO): a prospective study in China. Int J Infect Dis. 2020;93:77–83. https://doi.org/10.1016/j.ijid.2020.01.030 . (PMID: 10.1016/j.ijid.2020.01.03031982625)
Slart R, Nienhuis PH, Glaudemans A, Brouwer E, Gheysens O, van der Geest KSM. Role of (18)F-FDG PET/CT in large Vessel vasculitis and Polymyalgia Rheumatica. J Nucl Med. 2023;64:515–21. https://doi.org/10.2967/jnumed.122.265016 . (PMID: 10.2967/jnumed.122.26501637011940)
Ludwig DR, Amin TN, Manson JJ. Suspected systemic rheumatic Diseases in adults presenting with Fever. Best Pract Res Clin Rheumatol. 2019;33:101426. https://doi.org/10.1016/j.berh.2019.06.008 . (PMID: 10.1016/j.berh.2019.06.00831810543)
Buch-Olsen KM, Andersen RV, Hess S, Braad PE, Schifter S. 18F-FDG-PET/CT in Fever of unknown origin: clinical value. Nucl Med Commun. 2014;35:955–60. https://doi.org/10.1097/mnm.0000000000000146 . (PMID: 10.1097/mnm.000000000000014624801131)
Tsuzuki S, Watanabe A, Iwata M, Toyama H, Terasawa T. Predictors of diagnostic contributions and spontaneous remission of symptoms Associated with Positron Emission Tomography with Fluorine-18-Fluorodeoxy glucose combined with computed tomography in Classic Fever or inflammation of unknown origin: a retrospective study. J Korean Med Sci. 2021;36:e150. https://doi.org/10.3346/jkms.2021.36.e150 . (PMID: 10.3346/jkms.2021.36.e150341005628185121)
Takeuchi M, Nihashi T, Gafter-Gvili A, García-Gómez FJ, Andres E, Blockmans D, et al. Association of 18F-FDG PET or PET/CT results with spontaneous remission in classic Fever of unknown origin: a systematic review and meta-analysis. Med (Baltim). 2018;97:e12909. https://doi.org/10.1097/md.0000000000012909 . (PMID: 10.1097/md.0000000000012909)
IHPA. National Hospital Cost Data Collection Report. In: Care H, editor. Public Sector, Round 24 Financial Year 2019-20. Sydney, NSW: Independent Health and Aged Care Pricing Authority; 2021. pp. 20–1.
Siddique SM, Tipton K, Leas B, Greysen SR, Mull NK, Lane-Fall M, et al. Interventions to reduce hospital length of stay in high-risk populations: a systematic review. JAMA Netw Open. 2021;4:e2125846–e. https://doi.org/10.1001/jamanetworkopen.2021.25846 . (PMID: 10.1001/jamanetworkopen.2021.25846345426158453321)
Mourad O, Palda V, Detsky AS. A Comprehensive evidence-based Approach to Fever of unknown origin. Arch Intern Med. 2003;163:545–51. https://doi.org/10.1001/archinte.163.5.545 . (PMID: 10.1001/archinte.163.5.54512622601)

Keywords: Cost of Illness; FDG-PET/CT; FUO; Fever of unknown origin; PUO; Pyrexia of unknown origin

0Z5B2CJX4D (Fluorodeoxyglucose F18)
0 (Radiopharmaceuticals)

Date Created: 20231206 Date Completed: 20240322 Latest Revision: 20240913

20240914

10.1007/s00259-023-06548-y

38057651