OUTCOMES AND COSTS OF POSITRON EMISSION TOMOGRAPHY - COMPARISON OF INTRAVENOUS ADENOSINE AND INTRAVENOUS DIPYRIDAMOLE

The objective of this study was to compare the cost of intravenous ade nosine and intravenous dipyridamole in positron emission tomography (P ET) in patients with coronary artery disease. A retrospec tive, open-l abel, case-control, cost-effectiveness analysis was performed in the o ut patient nuclear medicine department of a university hospital. Thirt y-six patients underwent dipyridamole PET, and 72 matched patients und erwent adenosine PET. A cost-effectiveness analysis was conducted usin g a direct cost accounting approach to estimate institutional costs. K ey costs evaluated included acquisition cost, administration cost, mon itoring cost, cost of management of side effects, and cost of follow-u p care. The total cost of adenosine PET and dipyridamole PET was divid ed by their respective predictive accuracies to provide a total cost a djusted for efficacy. Adenosine increased heart rate and lowered systo lic blood pressure to a significantly greater extent than dipyridamole . The number of patients experiencing adverse drug reactions was signi ficantly greater for adenosine (82%) than for dipyridamole (67%), but the frequency of prolonged (>5 minutes) and late-onset side effects wa s significantly greater for dipyridamole than for adenosine. The frequ ency of side effects requiring medical intervention was also significa ntly greater for dipyridamole (53%) than for adenosine (6%). Although adenosine had a significantly greater acquisition cost than dipyridamo le, costs of monitoring, management of side effects, and follow-up car e were significantly less for adenosine than for dipyridamole. As a re sult, the total cost of using dipyridamole is significantly greater ($ 928.00 per patient) than the total cost of using adenosine ($672.00 pe r patient). Based on these results, adenosine may be the drug of choic e for pharmacologic vasodilation for PET.