Analysis of cost-effectiveness in the diagnosis of fever of unknown origin and the role of 18F-FDG PET–CT: A proposal of diagnostic algorithm

Determinants of diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin

“…In our study, 18 F-FDG PET/CT was performed despite a previous CT scan of the chest or the abdomen in 60% of the cases. However, early 18 F-FDG PET/CT may shorten the period of diagnostics and disease as well as save cost in the amount of 5471 euros per patient [29] as it may avoid the need for further futile investigations [14,15]. In our institution, the costs of a whole-body 18 F-FDG PET/CT are approximately twice as high as the cost of a contrast-enhanced CT of the thorax and abdomen.…”

Diagnostic performance of 18F-FDG PET/CT in patients with fever of unknown origin

“…Value of 18 F-FDG PET/CT in FUO Hao et al 685 Kei et al [10] Bleeker-Rovers et al [11] Becerra Nakayo et al [12] Castaigne et al [13] Castaigne et al [14] Balink et al [15] Balink et al [16] Kubota et al [17] Kubota et al [18] Keidar et al [6] Pelosi et al [19] Seshadri et al [20] Federici et al [21] Kim et al [22] Kim et al [ Plot of individual studies and pooled sensitivity of 18 F-fluorodeoxyglucose PET/CT on a per-patient-based analysis, including 95% confidence interval. The size of the circles indicates the weight of each study.…”

“…However, with the number of hospitals with PET/CT scanners increasing, 18 F-FDG PET/CT will soon become a cost-effective examination considering its high diagnostic result, because accurate early diagnosis limits the number of other futile examinations, the time to diagnosis, and the duration of hospitalization due to FUO. Becerra Nakayo et al [12] analyzed the cost involved in the management of FUO before performing a PET/CT and reported that the PET/CT study could be cost-effective in the management of FUO if ordered at an early stage as it can help establish an early diagnosis, reduce the number of hospitalization days for diagnosis, and avoid the repetition of unnecessary tests. Keidar et al [6] studied the negative predictive value of 18 F-FDG PET/CT for the assessment of FUO in adults.…”

EANM/SNMMI Guideline for18F-FDG Use in Inflammation and Infection

“…• Evaluation of fever of unknown origin (FUO) (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), including true FUO (defined according to the criteria of Durack and Street (44)), postoperative fever and recurrent sepsis, immunodeficiency (both induced and acquired)-related FUO, neutropenic fever, and isolated acute-phase inflammation markers (persistently raised C-reactive protein and/or erythrocyte sedimentation rate).…”