Balink H, Tan S S, Veeger N J G M, Holleman F, van Eck-Smit B L F, Bennink R J, Verberne H J
Department of Nuclear Medicine, Medical Center Leeuwarden, P.O. Box 850, 8901 BR, Leeuwarden, The Netherlands,
Eur J Nucl Med Mol Imaging. 2015 Aug;42(9):1408-13. doi: 10.1007/s00259-015-3010-0. Epub 2015 Feb 6.
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.
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.
In group A a diagnosis was reached in 14 of the 46 patients. The mean cost per patient of all the diagnostic procedures was
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.
炎症参数升高、无发热的非特异性体征和症状且经过各种诊断程序后仍未确诊的患者是诊断难题，被称为不明原因炎症（IUO）。本初步研究的目的是使用已发表的数据集作为参考，比较在IUO患者中进行与不进行（18）F-FDG PET/CT诊断检查/策略的成本效益。
选取未进行（18）F-FDG PET/CT的IUO患者（A组，46例）和转诊进行（18）F-FDG PET/CT的IUO患者（B组，46例）。IUO定义为非特异性体征和症状与红细胞沉降率（ESR）延长的组合，男性ESR定义为≥年龄/2，女性定义为≥（年龄+10）/2（ESR单位为毫米/小时，年龄单位为岁），和/或C反应蛋白（CRP）≥15mg/l。使用当前荷兰收费标准计算每位患者达到诊断所需的所有检查和程序的费用以及住院天数。
A组46例患者中有14例确诊。所有诊断程序的每位患者平均费用<2051欧元，包括住院费用为12614欧元。B组46例患者中有32例确诊。所有诊断程序的每位患者平均费用为1821欧元，显著低于A组（p<0.0002），包括住院费用为5298欧元。
在IUO中，（18）F-FDG PET/CT有可能成为一种具有成本效益的常规成像技术，为进一步的诊断决策指明方向，从而避免不必要的、侵入性的和昂贵的诊断检查，并可能缩短住院时间。然而，在将这些初步数据外推至临床实践之前，有必要进行一项前瞻性多中心“自下而上的微观成本核算”成本效益研究。
