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

Eur J Nucl Med Mol Imaging. 2008 Jul;35(7):1367-76. doi: 10.1007/s00259-008-0777-2. Epub 2008 Apr 2.


Purpose: (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.

Conclusion: 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.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Belgium
  • Cost-Benefit Analysis
  • Dopamine Plasma Membrane Transport Proteins / metabolism
  • Humans
  • Iodine Radioisotopes*
  • Markov Chains
  • Models, Economic
  • Parkinsonian Disorders / diagnosis*
  • Parkinsonian Disorders / diagnostic imaging*
  • Parkinsonian Disorders / economics
  • Parkinsonian Disorders / metabolism
  • Parkinsonian Disorders / therapy
  • Radiopharmaceuticals
  • Tomography, Emission-Computed, Single-Photon / economics*
  • Tropanes*


  • Dopamine Plasma Membrane Transport Proteins
  • Iodine Radioisotopes
  • Radiopharmaceuticals
  • Tropanes
  • 2-carbomethoxy-8-(3-fluoropropyl)-3-(4-iodophenyl)tropane