The cost effectiveness of 123I-FP-CIT SPECT imaging in patients with an uncertain clinical diagnosis of parkinsonism.
OBJECTIVE
(123)I-N-omega-fluoropropyl-2-beta-carboxymethoxy-3beta-(4-iodophenyl)nortropane ((123)I-FP-CIT) Single-photon emission computed tomography (SPECT) has been suggested to be a useful diagnostic adjunct in patients with clinically uncertain parkinsonism. We developed a pharmaco-economic (PE) model, evaluating the cost effectiveness of adding (123)I-FP-CIT SPECT to the diagnostic workup. As the model was developed before application of the diagnostic technique in real practice, a predictive validity assessment was performed based on data from a large nationwide patient registry in these patients.


METHODS
A PE model, using a Markov state transition model, was created, based on literature-derived and clinical expert panel data. Effects were expressed as adequately treated years (ATY). Key input data were compared to the real-life patterns in a nationwide multi-centre clinical setting, based on a complete national registry of 1,701 consecutive patients. The change in initial diagnosis and alteration of management of the patient after SPECT were registered.


RESULTS
In the PE model, it was calculated that management would change in 48.5% of patients by SPECT and that, over a 5-year period, 1.2 ATYs could be gained at a yearly additional cost of 72 euro. From the studied 1,701 patients, nigrostriatal degeneration was observed in 59.8%, the initial diagnosis was changed in 51.5%, management was altered in 49%, and cost effectiveness was increased to 358 euro per ATY.


CONCLUSIONS
Good correspondence between assumed and observed changes in patient management was found, indicating that (123)I-FP-CIT SPECT is influential in diagnosis and management of patients with uncertain clinical diagnosis of parkinsonism. This can be achieved at a marginal added cost to the health insurance and leads to a significant gain in ATY.
Van Laere
Koen
K
Division of Nuclear Medicine, University Hospital Leuven Gasthuisberg, E901, Herestraat 49, 3000 Leuven, Belgium. koen.vanlaere@uzleuven.be
Everaert
Ludwig
L
Annemans
Lieven
L
Gonce
Michel
M
Vandenberghe
Wim
W
Vander Borght
Thierry
T
D001530:Belgium; D003362:Cost-Benefit Analysis; D050483:Dopamine Plasma Membrane Transport Proteins / Q000378:metabolism; D006801:Humans; D007457:Iodine Radioisotopes; D008390:Markov Chains; D018803:Models, Economic; D020734:Parkinsonian Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000191:economics / Q000378:metabolism / Q000628:therapy; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon / Q000191:economics*; D014326:Tropanes
D050483:Dopamine Plasma Membrane Transport Proteins; D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D014326:Tropanes; C087552:2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane