Dopamine transporter imaging and SPECT in diagnostic work-up of Parkinson's disease: a decision-analytic approach

Mov Disord. 2003 Oct:18 Suppl 7:S52-62. doi: 10.1002/mds.10580.


As a diagnostic test for patients with suspected Parkinson's disease (PD), single photon emission computed tomography (SPECT) using [(123)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 [(123)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 euro;789 per investigation. Based on our model, expected costs (and ATME) were euro;946 (52.85 ATME) for EXAM+, euro;1352 (53.40 ATME) for DOUBLE+, euro;1731 (32.82 ATME) for SINGLE+, and euro;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 euro;733 per ATME gained. In sensitivity analyses, the ICER of DOUBLE+ versus EXAM+ ranged from euro;63 to euro;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 [(123)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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ambulatory Care Facilities / economics
  • Brain / diagnostic imaging*
  • Cost-Benefit Analysis / statistics & numerical data
  • Decision Trees*
  • Dihydroxyphenylalanine / analogs & derivatives*
  • Dopamine Plasma Membrane Transport Proteins
  • Germany
  • Health Care Costs / statistics & numerical data
  • Humans
  • Membrane Glycoproteins*
  • Membrane Transport Proteins / analysis*
  • National Health Programs / economics
  • Nerve Tissue Proteins*
  • Neurologic Examination* / economics
  • Parkinson Disease / diagnostic imaging*
  • Parkinson Disease / economics
  • Prospective Payment System / economics
  • Referral and Consultation / economics
  • Tomography, Emission-Computed, Single-Photon* / economics


  • Dopamine Plasma Membrane Transport Proteins
  • Membrane Glycoproteins
  • Membrane Transport Proteins
  • Nerve Tissue Proteins
  • fluorodopa F 18
  • Dihydroxyphenylalanine