Dopamine transporter imaging and SPECT in diagnostic work-up of Parkinson's disease: A decision-analytic approach
Identifieur interne : 002346 ( PascalFrancis/Corpus ); précédent : 002345; suivant : 002347Dopamine transporter imaging and SPECT in diagnostic work-up of Parkinson's disease: A decision-analytic approach
Auteurs : Richard C. Dodel ; Helmut Höffken ; J. Carsten Möller ; Bernhard Bornschein ; Thomas Klockgether ; Thomas Behr ; Wolfgang H. Oertel ; Uwe SiebertSource :
- Movement disorders [ 0885-3185 ] ; 2003.
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- Pascal (Inist)
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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.
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| NO : | PASCAL 04-0116261 INIST |
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| ET : | Dopamine transporter imaging and SPECT in diagnostic work-up of Parkinson's disease: A decision-analytic approach |
| AU : | DODEL (Richard C.); HÖFFKEN (Helmut); MÖLLER (J. Carsten); BORNSCHEIN (Bernhard); KLOCKGETHER (Thomas); BEHR (Thomas); OERTEL (Wolfgang H.); SIEBERT (Uwe); LEES (Andrew J.); GROSSET (Donald G.) |
| AF : | Department of Neurology, Friedrich-Wilhelms-University/Bonn/Allemagne (1 aut., 4 aut., 5 aut.); Department of Nuclear Medicine, Philipps-University/Marburg/Allemagne (2 aut., 6 aut.); Department of Neurology, Philipps-University/Marburg/Allemagne (3 aut., 7 aut.); Harvard Center for Risk Analysis, Harvard School of Public Health/Boston, Massachusetts/Etats-Unis (8 aut.); Bavarian Public Health Research and Coordination Center, Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich/Munich/Allemagne (8 aut.); Rita Lila Weston Institute of Neurological Studies/London/Royaume-Uni (1 aut.); Institute of Neurological Sciences/Glasgow/Royaume-Uni (2 aut.) |
| DT : | Publication en série; Niveau analytique |
| SO : | Movement disorders; ISSN 0885-3185; Etats-Unis; Da. 2003; Vol. 18; No. SUP7; S52-S62; Bibl. 22 ref. |
| LA : | Anglais |
| EA : | 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. |
| CC : | 002B17G |
| FD : | Parkinson maladie; Tomoscintigraphie émission monophotonique; Transport biologique; Dopamine; Analyse coût efficacité; Coût; Allemagne; Arbre décision; Diagnostic; Economie santé; Homme |
| FG : | Europe; Système nerveux pathologie; Système nerveux central pathologie; Encéphale pathologie; Extrapyramidal syndrome; Maladie dégénérative; Exploration radioisotopique; Santé publique |
| ED : | Parkinson disease; Single photon emission tomography; Biological transport; Dopamine; Cost efficiency analysis; Costs; Germany; Decision tree; Diagnosis; Health economy; Human |
| EG : | Europe; Nervous system diseases; Central nervous system disease; Cerebral disorder; Extrapyramidal syndrome; Degenerative disease; Radionuclide study; Public health |
| SD : | Parkinson enfermedad; Tomografía emisión fotón único; Transporte biológico; Dopamina; Análisis costo eficacia; Coste; Alemania; Arbol decisión; Diagnóstico; Economía salud; Hombre |
| LO : | INIST-20953.354000113382420090 |
| ID : | 04-0116261 |
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Pascal:04-0116261Le document en format XML
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Dodel</name><affiliation><inist:fA14 i1="01"><s1>Department of Neurology, Friedrich-Wilhelms-University</s1><s2>Bonn</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Hoffken, Helmut" sort="Hoffken, Helmut" uniqKey="Hoffken H" first="Helmut" last="Höffken">Helmut Höffken</name><affiliation><inist:fA14 i1="02"><s1>Department of Nuclear Medicine, Philipps-University</s1><s2>Marburg</s2><s3>DEU</s3><sZ>2 aut.</sZ><sZ>6 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Moller, J Carsten" sort="Moller, J Carsten" uniqKey="Moller J" first="J. Carsten" last="Möller">J. Carsten Möller</name><affiliation><inist:fA14 i1="03"><s1>Department of Neurology, Philipps-University</s1><s2>Marburg</s2><s3>DEU</s3><sZ>3 aut.</sZ><sZ>7 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Bornschein, Bernhard" sort="Bornschein, Bernhard" uniqKey="Bornschein B" first="Bernhard" last="Bornschein">Bernhard Bornschein</name><affiliation><inist:fA14 i1="01"><s1>Department of Neurology, Friedrich-Wilhelms-University</s1><s2>Bonn</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Klockgether, Thomas" sort="Klockgether, Thomas" uniqKey="Klockgether T" first="Thomas" last="Klockgether">Thomas Klockgether</name><affiliation><inist:fA14 i1="01"><s1>Department of Neurology, Friedrich-Wilhelms-University</s1><s2>Bonn</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Behr, Thomas" sort="Behr, Thomas" uniqKey="Behr T" first="Thomas" last="Behr">Thomas Behr</name><affiliation><inist:fA14 i1="02"><s1>Department of Nuclear Medicine, Philipps-University</s1><s2>Marburg</s2><s3>DEU</s3><sZ>2 aut.</sZ><sZ>6 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Oertel, Wolfgang H" sort="Oertel, Wolfgang H" uniqKey="Oertel W" first="Wolfgang H." last="Oertel">Wolfgang H. Oertel</name><affiliation><inist:fA14 i1="03"><s1>Department of Neurology, Philipps-University</s1><s2>Marburg</s2><s3>DEU</s3><sZ>3 aut.</sZ><sZ>7 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Siebert, Uwe" sort="Siebert, Uwe" uniqKey="Siebert U" first="Uwe" last="Siebert">Uwe Siebert</name><affiliation><inist:fA14 i1="04"><s1>Harvard Center for Risk Analysis, Harvard School of Public Health</s1><s2>Boston, Massachusetts</s2><s3>USA</s3><sZ>8 aut.</sZ></inist:fA14></affiliation><affiliation><inist:fA14 i1="05"><s1>Bavarian Public Health Research and Coordination Center, Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich</s1><s2>Munich</s2><s3>DEU</s3><sZ>8 aut.</sZ></inist:fA14></affiliation></author></analytic><series><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno><imprint><date when="2003">2003</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Movement disorders</title><title level="j" type="abbreviated">Mov. disord.</title><idno type="ISSN">0885-3185</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Biological transport</term><term>Cost efficiency analysis</term><term>Costs</term><term>Decision tree</term><term>Diagnosis</term><term>Dopamine</term><term>Germany</term><term>Health economy</term><term>Human</term><term>Parkinson disease</term><term>Single photon emission tomography</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term><term>Tomoscintigraphie émission monophotonique</term><term>Transport biologique</term><term>Dopamine</term><term>Analyse coût efficacité</term><term>Coût</term><term>Allemagne</term><term>Arbre décision</term><term>Diagnostic</term><term>Economie santé</term><term>Homme</term></keywords></textClass></profileDesc></teiHeader><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 [<sup>123</sup>I]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 [<sup>123</sup>I]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 [<sup>123</sup>I]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.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0885-3185</s0></fA01><fA03 i2="1"><s0>Mov. disord.</s0></fA03><fA05><s2>18</s2></fA05><fA06><s3>SUP7</s3></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Dopamine transporter imaging and SPECT in diagnostic work-up of Parkinson's disease: A decision-analytic approach</s1></fA08><fA09 i1="01" i2="1" l="ENG"><s1>Dopamine transporter imaging</s1></fA09><fA11 i1="01" i2="1"><s1>DODEL (Richard C.)</s1></fA11><fA11 i1="02" i2="1"><s1>HÖFFKEN (Helmut)</s1></fA11><fA11 i1="03" i2="1"><s1>MÖLLER (J. Carsten)</s1></fA11><fA11 i1="04" i2="1"><s1>BORNSCHEIN (Bernhard)</s1></fA11><fA11 i1="05" i2="1"><s1>KLOCKGETHER (Thomas)</s1></fA11><fA11 i1="06" i2="1"><s1>BEHR (Thomas)</s1></fA11><fA11 i1="07" i2="1"><s1>OERTEL (Wolfgang H.)</s1></fA11><fA11 i1="08" i2="1"><s1>SIEBERT (Uwe)</s1></fA11><fA12 i1="01" i2="1"><s1>LEES (Andrew J.)</s1><s9>introd.</s9></fA12><fA12 i1="02" i2="1"><s1>GROSSET (Donald G.)</s1><s9>ed.</s9></fA12><fA14 i1="01"><s1>Department of Neurology, Friedrich-Wilhelms-University</s1><s2>Bonn</s2><s3>DEU</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ></fA14><fA14 i1="02"><s1>Department of Nuclear Medicine, Philipps-University</s1><s2>Marburg</s2><s3>DEU</s3><sZ>2 aut.</sZ><sZ>6 aut.</sZ></fA14><fA14 i1="03"><s1>Department of Neurology, Philipps-University</s1><s2>Marburg</s2><s3>DEU</s3><sZ>3 aut.</sZ><sZ>7 aut.</sZ></fA14><fA14 i1="04"><s1>Harvard Center for Risk Analysis, Harvard School of Public Health</s1><s2>Boston, Massachusetts</s2><s3>USA</s3><sZ>8 aut.</sZ></fA14><fA14 i1="05"><s1>Bavarian Public Health Research and Coordination Center, Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich</s1><s2>Munich</s2><s3>DEU</s3><sZ>8 aut.</sZ></fA14><fA15 i1="01"><s1>Rita Lila Weston Institute of Neurological Studies</s1><s2>London</s2><s3>GBR</s3><sZ>1 aut.</sZ></fA15><fA15 i1="02"><s1>Institute of Neurological Sciences</s1><s2>Glasgow</s2><s3>GBR</s3><sZ>2 aut.</sZ></fA15><fA20><s2>S52-S62</s2></fA20><fA21><s1>2003</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>20953</s2><s5>354000113382420090</s5></fA43><fA44><s0>0000</s0><s1>© 2004 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>22 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>04-0116261</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Movement disorders</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>As a diagnostic test for patients with suspected Parkinson's disease (PD), single photon emission computed tomography (SPECT) using [<sup>123</sup>I]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 [<sup>123</sup>I]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 [<sup>123</sup>I]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.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17G</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Parkinson maladie</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Parkinson disease</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Parkinson enfermedad</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Tomoscintigraphie émission monophotonique</s0><s5>04</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Single photon emission tomography</s0><s5>04</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Tomografía emisión fotón único</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Transport biologique</s0><s5>07</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Biological transport</s0><s5>07</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Transporte biológico</s0><s5>07</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Dopamine</s0><s2>NK</s2><s2>FR</s2><s5>08</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Dopamine</s0><s2>NK</s2><s2>FR</s2><s5>08</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Dopamina</s0><s2>NK</s2><s2>FR</s2><s5>08</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Analyse coût efficacité</s0><s5>10</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Cost efficiency analysis</s0><s5>10</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Análisis costo eficacia</s0><s5>10</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Coût</s0><s5>11</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Costs</s0><s5>11</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Coste</s0><s5>11</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Allemagne</s0><s2>NG</s2><s5>12</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Germany</s0><s2>NG</s2><s5>12</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Alemania</s0><s2>NG</s2><s5>12</s5></fC03><fC03 i1="08" i2="X" l="FRE"><s0>Arbre décision</s0><s5>13</s5></fC03><fC03 i1="08" i2="X" l="ENG"><s0>Decision tree</s0><s5>13</s5></fC03><fC03 i1="08" i2="X" l="SPA"><s0>Arbol decisión</s0><s5>13</s5></fC03><fC03 i1="09" i2="X" l="FRE"><s0>Diagnostic</s0><s5>17</s5></fC03><fC03 i1="09" i2="X" l="ENG"><s0>Diagnosis</s0><s5>17</s5></fC03><fC03 i1="09" i2="X" l="SPA"><s0>Diagnóstico</s0><s5>17</s5></fC03><fC03 i1="10" i2="X" l="FRE"><s0>Economie santé</s0><s5>18</s5></fC03><fC03 i1="10" i2="X" l="ENG"><s0>Health economy</s0><s5>18</s5></fC03><fC03 i1="10" i2="X" l="SPA"><s0>Economía salud</s0><s5>18</s5></fC03><fC03 i1="11" i2="X" l="FRE"><s0>Homme</s0><s5>20</s5></fC03><fC03 i1="11" i2="X" l="ENG"><s0>Human</s0><s5>20</s5></fC03><fC03 i1="11" i2="X" l="SPA"><s0>Hombre</s0><s5>20</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Europe</s0><s2>NG</s2></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Europe</s0><s2>NG</s2></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Europa</s0><s2>NG</s2></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Système nerveux pathologie</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>37</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Système nerveux central pathologie</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>38</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Encéphale pathologie</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>39</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>40</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>41</s5></fC07><fC07 i1="07" i2="X" l="FRE"><s0>Exploration radioisotopique</s0><s5>45</s5></fC07><fC07 i1="07" i2="X" l="ENG"><s0>Radionuclide study</s0><s5>45</s5></fC07><fC07 i1="07" i2="X" l="SPA"><s0>Exploración radioisotópica</s0><s5>45</s5></fC07><fC07 i1="08" i2="X" l="FRE"><s0>Santé publique</s0><s5>61</s5></fC07><fC07 i1="08" i2="X" l="ENG"><s0>Public health</s0><s5>61</s5></fC07><fC07 i1="08" i2="X" l="SPA"><s0>Salud pública</s0><s5>61</s5></fC07><fN21><s1>075</s1></fN21><fN82><s1>PSI</s1></fN82></pA></standard><server><NO>PASCAL 04-0116261 INIST</NO><ET>Dopamine transporter imaging and SPECT in diagnostic work-up of Parkinson's disease: A decision-analytic approach</ET><AU>DODEL (Richard C.); HÖFFKEN (Helmut); MÖLLER (J. Carsten); BORNSCHEIN (Bernhard); KLOCKGETHER (Thomas); BEHR (Thomas); OERTEL (Wolfgang H.); SIEBERT (Uwe); LEES (Andrew J.); GROSSET (Donald G.)</AU><AF>Department of Neurology, Friedrich-Wilhelms-University/Bonn/Allemagne (1 aut., 4 aut., 5 aut.); Department of Nuclear Medicine, Philipps-University/Marburg/Allemagne (2 aut., 6 aut.); Department of Neurology, Philipps-University/Marburg/Allemagne (3 aut., 7 aut.); Harvard Center for Risk Analysis, Harvard School of Public Health/Boston, Massachusetts/Etats-Unis (8 aut.); Bavarian Public Health Research and Coordination Center, Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University of Munich/Munich/Allemagne (8 aut.); Rita Lila Weston Institute of Neurological Studies/London/Royaume-Uni (1 aut.); Institute of Neurological Sciences/Glasgow/Royaume-Uni (2 aut.)</AF><DT>Publication en série; Niveau analytique</DT><SO>Movement disorders; ISSN 0885-3185; Etats-Unis; Da. 2003; Vol. 18; No. SUP7; S52-S62; Bibl. 22 ref.</SO><LA>Anglais</LA><EA>As a diagnostic test for patients with suspected Parkinson's disease (PD), single photon emission computed tomography (SPECT) using [<sup>123</sup>I]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 [<sup>123</sup>I]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 [<sup>123</sup>I]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.</EA><CC>002B17G</CC><FD>Parkinson maladie; Tomoscintigraphie émission monophotonique; Transport biologique; Dopamine; Analyse coût efficacité; Coût; Allemagne; Arbre décision; Diagnostic; Economie santé; Homme</FD><FG>Europe; Système nerveux pathologie; Système nerveux central pathologie; Encéphale pathologie; Extrapyramidal syndrome; Maladie dégénérative; Exploration radioisotopique; Santé publique</FG><ED>Parkinson disease; Single photon emission tomography; Biological transport; Dopamine; Cost efficiency analysis; Costs; Germany; Decision tree; Diagnosis; Health economy; Human</ED><EG>Europe; Nervous system diseases; Central nervous system disease; Cerebral disorder; Extrapyramidal syndrome; Degenerative disease; Radionuclide study; Public health</EG><SD>Parkinson enfermedad; Tomografía emisión fotón único; Transporte biológico; Dopamina; Análisis costo eficacia; Coste; Alemania; Arbol decisión; Diagnóstico; Economía salud; Hombre</SD><LO>INIST-20953.354000113382420090</LO><ID>04-0116261</ID></server></inist></record>Pour manipuler ce document sous Unix (Dilib)
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