Abstract
Background
Our study aims to explore the current utilisation of 18F-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.
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Data Availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- PUO:
-
Pyrexia of unknown origin
- FDG-PET/CT:
-
18F-fluorodeoxyglucose positron emission tomography combined with computed tomography
- COI:
-
Cost of illness
- NIID:
-
Non-infectious inflammatory disease
- CT:
-
Computed tomography
- MRI:
-
Magnetic resonance imaging
- US:
-
Ultrasound
- HITH:
-
Hospital-in-the-home
- TP:
-
True positive
- TN:
-
True negative
- FN:
-
False negative
- FP:
-
False positive
- PPV:
-
Positive predictive value
- NPV:
-
Negative predictive value
- IQR:
-
Interquartile range
- LOS:
-
Length of stay
- $AUD:
-
Australian Dollar
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BL participated in the study design, data collection, and data analysis and prepared the manuscript. ES, MH, RM participated in data collection. RM, STL, AMTP and AMS participated in the study design and revision of the manuscript. All authors read and approved the final manuscript.
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Liu, B., Ma, R., Shum, E. et al. FDG-PET/CT for investigation of pyrexia of unknown origin: a cost of illness analysis. Eur J Nucl Med Mol Imaging 51, 1287–1296 (2024). https://doi.org/10.1007/s00259-023-06548-y
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DOI: https://doi.org/10.1007/s00259-023-06548-y