Cost-effectiveness in diagnosis of patients with long-standing fever.

INTRODUCTION: It is difficult to make an adequate diagnosis regarding patients with fever of unknown origin (FUO). The cases require time-consuming and costly investigations. Our study features a cost-effectiveness analysis and the development of an alternative diagnostic model. The diagnostic programmes include: serological and microbiological tests, blood laboratory test, radiological, histopathological and radionuclide tests. PATIENTS AND METHODS: For 100 hospitalized patients with fever (group A: > 38.0 degrees C for as long as 7 days; group B: > 38.3 degrees C for 3 weeks), the various results of clinical investigations were obtained, and the costs of a three-step programme for the four main diagnoses, including the diagnostic value, were evaluated.
RESULTS: There was no significant difference between male and female patients, or patients < 35 vs. > 35, and < 50 vs. > 50 years. Infections were found in 46%, neoplasma and collagen-vascular disease/autoimmune disorders in 10% each, and other diseases in 20% of all patients. The third diagnostic programme was the most expensive in all four disease categories. In total, 30, 34, and 22 patients were diagnosed by the three diagnostic steps, respectively. In 14 patients no diagnosis was found. The overall cost of the three diagnostic programmes was 359, 1,996 and 3,496 EUR, respectively.
CONCLUSIONS: In the majority of the cases (64%), the first and second diagnostic programmes result in a diagnosis. The investigations of the third diagnostic programme are more accurate, more expensive, and result in a diagnosis, mainly in patients of group B. Our proposed new diagnostic model would save 134, 746, and 558 EUR for each diagnostic step, respectively.