Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, Division of Infectious Diseases, University Health Network, Toronto, ON, Canada.
Clin Microbiol Infect. 2023 Nov;29(11):1417-1423. doi: 10.1016/j.cmi.2023.06.022. Epub 2023 Jun 21.
The use of positron emission tomography/computed tomography (PET/CT) in the evaluation of patients with Staphylococcus aureus bacteraemia can improve the diagnosis of infectious foci and guide clinical management. We aimed to evaluate the cost-utility of PET/CT among adults hospitalized with Staphylococcus aureus bacteraemia.
A cost-utility analysis was conducted from the healthcare payer perspective using a probabilistic Markov cohort model assessing three diagnostic strategies: (a) PET/CT in all patients, (b) PET/CT in high-risk patients only, and (c) routine diagnostic workup. Primary outcomes were quality-adjusted life years (QALYs), costs in Canadian dollars, and an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analyses were conducted to evaluate parameter uncertainty.
Routine workup resulted in an average of 16.64 QALYs from the time of diagnosis at a lifetime cost of $209 060/patient. This was dominated by PET/CT in high-risk patients (i.e. greater effectiveness at lower costs) with average 16.88 QALYs at a cost of $199 552. Compared with PET/CT in high-risk patients only, PET/CT for all patients cost on average $11 960 more but resulted in 0.14 more QALYs, giving an incremental cost-effectiveness ratio of $83 500 (cost per additional QALY gained); however, there was a high degree of uncertainty comparing these two strategies. At a willingness-to-pay threshold of $50 000/QALY, PET/CT in high-risk patients was the most cost-effective strategy in 58.6% of simulations vs. 37.9% for PET/CT in all patients.
Our findings suggest that a strategy of using PET/CT in high-risk patients is more cost-effective than no PET/CT. Randomized controlled trials should be conducted to evaluate the use of PET/CT in different patient groups.
正电子发射断层扫描/计算机断层扫描（PET/CT）在评估金黄色葡萄球菌菌血症患者中的应用可以提高感染病灶的诊断能力，并指导临床管理。本研究旨在评估 PET/CT 在金黄色葡萄球菌菌血症住院患者中的成本效益。
采用决策分析模型，从医疗保健支付者的角度进行成本效用分析，评估了三种诊断策略：（a）所有患者均行 PET/CT，（b）高危患者行 PET/CT，（c）常规诊断。主要结局指标为质量调整生命年（QALYs）、加元成本和增量成本效果比。采用确定性和概率敏感性分析来评估参数不确定性。
常规诊断在患者确诊后的平均寿命内产生了 16.64 个 QALYs，成本为 209060 加元/患者。这一结果被高危患者行 PET/CT（即成本更低，效果更好）所主导，平均产生 16.88 个 QALYs，成本为 199552 加元。与仅对高危患者行 PET/CT 相比，对所有患者行 PET/CT 的平均成本增加了 11960 加元，但 QALY 增加了 0.14，增量成本效果比为 83500 加元（每增加一个 QALY 的成本）；然而，这两种策略之间存在高度不确定性。在 50000 加元/QALY 的意愿支付阈值下，对高危患者行 PET/CT 在 58.6%的模拟中是最具成本效益的策略，而对所有患者行 PET/CT 的策略为 37.9%。
本研究结果表明，对高危患者行 PET/CT 的策略比不进行 PET/CT 更具成本效益。应开展随机对照试验来评估 PET/CT 在不同患者群体中的应用。
