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FDG-PET/CT for investigation of pyrexia of unknown origin: a cost of illness analysis

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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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Author information

Authors and Affiliations

  1. Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia

    Bonnia Liu, Sze-Ting Lee, Aurora M. T. Poon & Andrew M. Scott

  2. Department of Rheumatology, Austin Health, Melbourne, VIC, Australia

    Bonnia Liu

  3. Department of Nuclear Medicine, Royal Melbourne Hospital, 300 Grattan St, Melbourne, VIC, Australia

    Bonnia Liu

  4. Department of Finance, Austin Health, Melbourne, VIC, Australia

    Ronald Ma

  5. University of Melbourne, Melbourne, VIC, Australia

    Ronald Ma, Sze-Ting Lee, Aurora M. T. Poon & Andrew M. Scott

  6. Department of General Medicine, Austin Health, Melbourne, VIC, Australia

    Evonne Shum & Maria Hormiz

  7. Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia

    Sze-Ting Lee & Andrew M. Scott

  8. La Trobe University, Melbourne, VIC, Australia

    Sze-Ting Lee & Andrew M. Scott

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Contributions

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.

Corresponding author

Correspondence to Bonnia Liu.

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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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