Dopamine transporter imaging and SPECT in diagnostic work‐up of Parkinson's disease: A decision‐analytic approach
Identifieur interne : 004121 ( Main/Exploration ); précédent : 004120; suivant : 004122Dopamine transporter imaging and SPECT in diagnostic work‐up of Parkinson's disease: A decision‐analytic approach
Auteurs : Richard C. Dodel [Allemagne] ; Helmut Höffken [Allemagne] ; J. Carsten Möller [Allemagne] ; Bernhard Bornschein [Allemagne] ; Thomas Klockgether [Allemagne] ; Thomas Behr [Allemagne] ; Wolfgang H. Oertel [Allemagne] ; Uwe Siebert [États-Unis, Allemagne]Source :
- Movement Disorders [ 0885-3185 ] ; 2003-10.
Descripteurs français
- Pascal (Inist)
- Wicri :
English descriptors
- KwdEn :
- Ambulatory Care Facilities (economics), Biological transport, Brain (radionuclide imaging), Cost efficiency analysis, Cost-Benefit Analysis (statistics & numerical data), Costs, Decision Trees, Decision tree, Diagnosis, Dihydroxyphenylalanine (analogs & derivatives), Dihydroxyphenylalanine (diagnostic use), Dopamine, Dopamine Plasma Membrane Transport Proteins, Germany, Health Care Costs (statistics & numerical data), Health economy, Human, Humans, Membrane Glycoproteins, Membrane Transport Proteins (analysis), National Health Programs (economics), Nerve Tissue Proteins, Neurologic Examination (economics), Parkinson Disease (economics), Parkinson Disease (radionuclide imaging), Parkinson disease, Parkinson's disease, Prospective Payment System (economics), Referral and Consultation (economics), SPECT, Single photon emission tomography, Tomography, Emission-Computed, Single-Photon (economics), [123I]FP‐CIT SPECT, cost, cost–effectiveness.
- MESH :
- chemical , analogs & derivatives : Dihydroxyphenylalanine.
- chemical , analysis : Membrane Transport Proteins.
- chemical , diagnostic use : Dihydroxyphenylalanine.
- geographic : Germany, Membrane Glycoproteins, Nerve Tissue Proteins.
- economics : Ambulatory Care Facilities, National Health Programs, Neurologic Examination, Parkinson Disease, Prospective Payment System, Referral and Consultation, Tomography, Emission-Computed, Single-Photon.
- radionuclide imaging : Brain, Parkinson Disease.
- statistics & numerical data : Cost-Benefit Analysis, Health Care Costs.
- Decision Trees, Dopamine Plasma Membrane Transport Proteins, Humans.
Abstract
As a diagnostic test for patients with suspected Parkinson's disease (PD), single photon emission computed tomography (SPECT) using [123I]FP‐CIT tracer has better sensitivity but is more expensive than regular clinical examination (CE). Our objective was to evaluate the clinical and economic impacts of different diagnostic strategies involving [123I]FP‐CIT SPECT. We developed a decision tree model to predict adequate treatment‐month equivalents (ATME), costs, and incremental cost–effectiveness ratio (ICER) during a 12‐month time horizon in patients with suspected PD referred to a specialized movement disorder outpatient clinic. In our cost– effectiveness analysis, we adopted the perspective of the German health care system and used data from a German prospective health care utilization study (n = 142) and published diagnostic studies. Compared strategies were CE only (EXAM+), SPECT only (SPECT+), SPECT following negative CE (SINGLE+), and SPECT following positive CE (DOUBLE+). Costs of SPECT amounted to €789 per investigation. Based on our model, expected costs (and ATME) were €946 (52.85 ATME) for EXAM+, €1352 (53.40 ATME) for DOUBLE+, €1731 (32.82 ATME) for SINGLE+, and €2003 (32.96 ATME) for SPECT+; performance of SPECT was induced in 0%, 54%, 56%, and 100% of the patients, respectively. DOUBLE+ was more effective and less expensive than SINGLE+ or SPECT+; thus these two do not offer reasonable choices. The ICER of DOUBLE+ compared to EXAM+ was €733 per ATME gained. In sensitivity analyses, the ICER of DOUBLE+ versus EXAM+ ranged from €63 to €2411 per ATME gained. Whether the diagnostic work‐up of patients referred to a specialized movement disorder clinic with a high prevalence of PD should include [123I]FP‐CIT SPECT depends on patient preferences and the decision maker's willingness to pay for adequate early treatment. SPECT should be used as a confirmatory test before treatment initiation and limited to patients with a positive test result in the clinical examination. These results should be adjusted to the specific setting and individual patient preferences. © 2003 Movement Disorder Society
Url:
DOI: 10.1002/mds.10580
Affiliations:
- Allemagne, États-Unis
- Bavière, District de Cologne, District de Giessen, District de Haute-Bavière, Hesse (Land), Massachusetts, Rhénanie-du-Nord-Westphalie
- Bonn, Marbourg, Munich
- Université Louis-et-Maximilien de Munich
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Le document en format XML
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Ambulatory Care Facilities (economics)</term>
<term>Biological transport</term>
<term>Brain (radionuclide imaging)</term>
<term>Cost efficiency analysis</term>
<term>Cost-Benefit Analysis (statistics & numerical data)</term>
<term>Costs</term>
<term>Decision Trees</term>
<term>Decision tree</term>
<term>Diagnosis</term>
<term>Dihydroxyphenylalanine (analogs & derivatives)</term>
<term>Dihydroxyphenylalanine (diagnostic use)</term>
<term>Dopamine</term>
<term>Dopamine Plasma Membrane Transport Proteins</term>
<term>Germany</term>
<term>Health Care Costs (statistics & numerical data)</term>
<term>Health economy</term>
<term>Human</term>
<term>Humans</term>
<term>Membrane Glycoproteins</term>
<term>Membrane Transport Proteins (analysis)</term>
<term>National Health Programs (economics)</term>
<term>Nerve Tissue Proteins</term>
<term>Neurologic Examination (economics)</term>
<term>Parkinson Disease (economics)</term>
<term>Parkinson Disease (radionuclide imaging)</term>
<term>Parkinson disease</term>
<term>Parkinson's disease</term>
<term>Prospective Payment System (economics)</term>
<term>Referral and Consultation (economics)</term>
<term>SPECT</term>
<term>Single photon emission tomography</term>
<term>Tomography, Emission-Computed, Single-Photon (economics)</term>
<term>[123I]FP‐CIT SPECT</term>
<term>cost</term>
<term>cost–effectiveness</term>
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<term>Membrane Glycoproteins</term>
<term>Nerve Tissue Proteins</term>
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<keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Ambulatory Care Facilities</term>
<term>National Health Programs</term>
<term>Neurologic Examination</term>
<term>Parkinson Disease</term>
<term>Prospective Payment System</term>
<term>Referral and Consultation</term>
<term>Tomography, Emission-Computed, Single-Photon</term>
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<keywords scheme="MESH" qualifier="radionuclide imaging" xml:lang="en"><term>Brain</term>
<term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Cost-Benefit Analysis</term>
<term>Health Care Costs</term>
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<keywords scheme="MESH" xml:lang="en"><term>Decision Trees</term>
<term>Dopamine Plasma Membrane Transport Proteins</term>
<term>Humans</term>
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<term>Analyse coût efficacité</term>
<term>Arbre décision</term>
<term>Coût</term>
<term>Diagnostic</term>
<term>Dopamine</term>
<term>Economie santé</term>
<term>Homme</term>
<term>Parkinson maladie</term>
<term>Tomoscintigraphie émission monophotonique</term>
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<front><div type="abstract" xml:lang="en">As a diagnostic test for patients with suspected Parkinson's disease (PD), single photon emission computed tomography (SPECT) using [123I]FP‐CIT tracer has better sensitivity but is more expensive than regular clinical examination (CE). Our objective was to evaluate the clinical and economic impacts of different diagnostic strategies involving [123I]FP‐CIT SPECT. We developed a decision tree model to predict adequate treatment‐month equivalents (ATME), costs, and incremental cost–effectiveness ratio (ICER) during a 12‐month time horizon in patients with suspected PD referred to a specialized movement disorder outpatient clinic. In our cost– effectiveness analysis, we adopted the perspective of the German health care system and used data from a German prospective health care utilization study (n = 142) and published diagnostic studies. Compared strategies were CE only (EXAM+), SPECT only (SPECT+), SPECT following negative CE (SINGLE+), and SPECT following positive CE (DOUBLE+). Costs of SPECT amounted to €789 per investigation. Based on our model, expected costs (and ATME) were €946 (52.85 ATME) for EXAM+, €1352 (53.40 ATME) for DOUBLE+, €1731 (32.82 ATME) for SINGLE+, and €2003 (32.96 ATME) for SPECT+; performance of SPECT was induced in 0%, 54%, 56%, and 100% of the patients, respectively. DOUBLE+ was more effective and less expensive than SINGLE+ or SPECT+; thus these two do not offer reasonable choices. The ICER of DOUBLE+ compared to EXAM+ was €733 per ATME gained. In sensitivity analyses, the ICER of DOUBLE+ versus EXAM+ ranged from €63 to €2411 per ATME gained. Whether the diagnostic work‐up of patients referred to a specialized movement disorder clinic with a high prevalence of PD should include [123I]FP‐CIT SPECT depends on patient preferences and the decision maker's willingness to pay for adequate early treatment. SPECT should be used as a confirmatory test before treatment initiation and limited to patients with a positive test result in the clinical examination. These results should be adjusted to the specific setting and individual patient preferences. © 2003 Movement Disorder Society</div>
</front>
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<affiliations><list><country><li>Allemagne</li>
<li>États-Unis</li>
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<region><li>Bavière</li>
<li>District de Cologne</li>
<li>District de Giessen</li>
<li>District de Haute-Bavière</li>
<li>Hesse (Land)</li>
<li>Massachusetts</li>
<li>Rhénanie-du-Nord-Westphalie</li>
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<tree><country name="Allemagne"><region name="Rhénanie-du-Nord-Westphalie"><name sortKey="Dodel, Richard C" sort="Dodel, Richard C" uniqKey="Dodel R" first="Richard C." last="Dodel">Richard C. Dodel</name>
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<name sortKey="Bornschein, Bernhard" sort="Bornschein, Bernhard" uniqKey="Bornschein B" first="Bernhard" last="Bornschein">Bernhard Bornschein</name>
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<name sortKey="Moller, J Carsten" sort="Moller, J Carsten" uniqKey="Moller J" first="J. Carsten" last="Möller">J. Carsten Möller</name>
<name sortKey="Oertel, Wolfgang H" sort="Oertel, Wolfgang H" uniqKey="Oertel W" first="Wolfgang H." last="Oertel">Wolfgang H. Oertel</name>
<name sortKey="Siebert, Uwe" sort="Siebert, Uwe" uniqKey="Siebert U" first="Uwe" last="Siebert">Uwe Siebert</name>
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<country name="États-Unis"><region name="Massachusetts"><name sortKey="Siebert, Uwe" sort="Siebert, Uwe" uniqKey="Siebert U" first="Uwe" last="Siebert">Uwe Siebert</name>
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