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Cost-effectiveness of routine (18)F-FDG PET/CT in high-risk patients with gram-positive bacteremia

Fidel J Vos1, Chantal P Bleeker-Rovers, Bart Jan Kullberg

  • 1Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. f.vos@aig.umcn.nl

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|October 11, 2011
PubMed
Abstract

Insights

Routine (18)F-FDG PET/CT imaging for gram-positive bacteremia significantly reduces mortality and relapse rates. This diagnostic approach is cost-effective, with costs per prevented death falling within efficient ranges according to Dutch guidelines.

Area of Science:

  • Nuclear Medicine
  • Infectious Diseases
  • Health Economics

Background:

  • Gram-positive bacteremia presents a significant health challenge with high morbidity and mortality rates.
  • Delayed diagnosis of metastatic infectious foci is a key factor in poor patient outcomes.
  • Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography ((18)F-FDG PET/CT) shows promise in detecting infections, potentially lowering relapse and mortality.

Purpose of the Study:

  • To conduct a cost-effectiveness analysis of integrating (18)F-FDG PET/CT into the diagnostic pathway for patients with gram-positive bacteremia.
  • To evaluate the impact of (18)F-FDG PET/CT on mortality and healthcare costs in this patient population.

Main Methods:

  • A cost-effectiveness analysis was performed alongside a prospective clinical study comparing an (18)F-FDG PET/CT group (n=115) with a matched control group (n=230).
  • Mortality at six months was the primary outcome measure for calculating the incremental cost-effectiveness ratio.
  • Costs associated with diagnostic procedures and patient management were analyzed.

Main Results:

  • Mortality was significantly lower in the (18)F-FDG PET/CT group (19%) compared to the control group (32%) (P < 0.01).
  • The incremental cost of the (18)F-FDG PET/CT strategy was $9,454, primarily driven by inpatient admission costs.
  • The incremental cost-effectiveness ratio was estimated at $72,487 per prevented death, a figure considered efficient by Dutch guidelines.

Conclusions:

  • Routine implementation of (18)F-FDG PET/CT in the diagnostic workup for gram-positive bacteremia effectively reduces morbidity and mortality.
  • While associated with increased costs, these are largely due to necessary inpatient treatment for metastatic infections.
  • (18)F-FDG PET/CT should be readily accessible for high-risk patients to facilitate early detection of metastatic disease.

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