IntegoTM Infusion System: cost effectiveness analysis focusing on dosimetry, sterility and management.

BACKGROUND: Healthcare providers across Europe are facing an ever-growing demand in clinical PET referrals. Currently, it is estimated that the administration of the PET tracer accounts for approximately 40% of the unitary PET procedure reimbursement (uPETr). Although the cost of PET/CT is highly dependant on the radiopharmaceutical cost itself, little is known about the economical impact of the utilized administration method and the repercussions on staff radiation exposure. Our objective was to evaluate the cost- effectiveness of automatic injection/fractionation system IntegoTM (Bayer HealthCare, MEDRAD Europe, Netherlands) for istaff radiation exposure reduction and to validate its use with 18F-choline (FCH).

METHODS: In order to validate IntegoTM use with FCH we analyzed sterility, radioactivity fractionation accuracy and radiation protection for staff . We analyzed IntegoTM impact on examination costs and its impact on organization efficiency. A cost-effectiveness analysis (CEA) was estimated as the incremental cost to reduce staff radiation exposure.

RESULTS: According to our data, IntegoTM ensures both sterility and accuracy of FCH doses' activity , reducing, at the same time, the exposure to radiation either whole body and at the extremities (94% and 75% respectively for the technicians and complete reduction for physicians). IntegoTM's variable unit costs are higher than the SA (respectively 1,8% and 0.4% of PET reimbursement), while staff costs are significantly higher with SA (respectively 0.27% and 1.57% of unitary PET reimbursement [uPETr]). In our simulation, based on a 2,450 PET yearly output, the differential costs were slightly higher by using IntegoTMTM (+ 14%). The incremental cost-effectiveness ratio (ICER) was equal to 1.1, i.e. the healthcare provider pays an additional cost of 0.38% of uPETr to obtain a significant reduction of staff radiation exposure (-4.5 μS).

CONCLUSION: IntegoTM, for its favorable results in terms of cost effectiveness, could be a useful tool in a nuclear medicine department, limiting the staff radiation exposure.