The cost effectiveness of 123I-FP-CIT SPECT imaging in patients with an uncertain clinical diagnosis of parkinsonism

  • Koen Van Laere
  • Ludwig Everaert
  • Lieven Annemans
  • Michel Gonce
  • Wim Vandenberghe
  • Thierry Vander Borght
Original Article

Abstract

Purpose

123I-N-ω-fluoropropyl-2-β-carboxymethoxy-3β-(4-iodophenyl)nortropane (123I-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 123I-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. 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 per ATY.

Conclusion

Good correspondence between assumed and observed changes in patient management was found, indicating that 123I-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.

Keywords

123I-FP-CIT Dopamine transporter Clinical impact Pharmaco-economic modelling 

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Koen Van Laere
    • 1
  • Ludwig Everaert
    • 2
  • Lieven Annemans
    • 3
  • Michel Gonce
    • 4
  • Wim Vandenberghe
    • 5
  • Thierry Vander Borght
    • 6
  1. 1.Division of Nuclear MedicineUniversity Hospital Leuven GasthuisbergLeuvenBelgium
  2. 2.Medical and Pharmaceutical InformationZemstBelgium
  3. 3.Department of Public HealthGhent UniversityGhentBelgium
  4. 4.Department of NeurologyCHU CitadelleLiègeBelgium
  5. 5.Department of NeurologyUniversity Hospital LeuvenLeuvenBelgium
  6. 6.Division of Nuclear Medicine, Mont-Godinne Medical CenterUniversité Catholique de LouvainYvoirBelgium

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