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Publication year
2011Source
The Journal of Nuclear Medicine (1978), 52, 11, (2011), pp. 1673-8ISSN
Publication type
Article / Letter to editor

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Organization
Internal Medicine
Health Evidence
IQ Healthcare
Nuclear Medicine
Former Organization
Epidemiology, Biostatistics & HTA
Journal title
The Journal of Nuclear Medicine (1978)
Volume
vol. 52
Issue
iss. 11
Page start
p. 1673
Page end
p. 8
Subject
N4i 1: Pathogenesis and modulation of inflammation; N4i 2: Invasive mycoses and compromised host NCMLS 1: Infection and autoimmunity; NCEBP 2:Evaluation of complex medical interventions ONCOL 4:Quality of Care; NCEBP 6: Quality of nursing and allied health careAbstract
Gram-positive bacteremia has a high morbidity and mortality rate of approximately 30%. Delayed diagnosis of clinically silent metastatic infectious foci is an important indicator for a complicated outcome. (18)F-FDG PET/CT allows detection of focal infection, resulting in lower relapse rates and mortality. Here, we present a cost-effectiveness analysis associated with introduction of (18)F-FDG PET/CT for patients with gram-positive bacteremia. METHODS: A cost-effectiveness analysis in a prospective (18)F-FDG PET/CT group (n = 115) and matched control group (n = 230) was performed alongside a clinical study, the results of which were previously published. Mortality at 6 mo was considered the final effect outcome and was used in the denominator of the incremental cost-effectiveness ratio. RESULTS: Mortality in the (18)F-FDG PET/CT group was 19%, compared with 32% in the control group (P < 0.01). Incremental costs of (18)F-FDG PET/CT were $9,454 (95% confidence interval [CI], $3,963-$14,947), mainly because of admission (mean, $6,631; 95% CI, $1,449-$11,814). Additional costs were related to echocardiography (P < 0.01), not to (18)F-FDG PET/CT (P = 0.8). The mean incremental costs of the (18)F-FDG PET/CT strategy estimated by stratification for endocarditis were $5,277 per patient (95% CI, $429-$10,123; P = 0.03). The point estimate of the incremental cost-effectiveness ratio is $72,487 per prevented death (95% CI, $11,388-$323,379). CONCLUSION: Introduction of a diagnostic regimen including routine (18)F-FDG PET/CT decreases morbidity and mortality. The cost increase is due to in-hospital treatment of metastatic infectious foci. Costs per prevented death, $72,487, are within the range that is considered to be efficient by Dutch guidelines. Patients with high-risk gram-positive bacteremia therefore should have easy access to (18)F-FDG PET/CT to enable early detection of metastatic infectious disease.
This item appears in the following Collection(s)
- Academic publications [227881]
- Electronic publications [107344]
- Faculty of Medical Sciences [86219]
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