Radionuclide scanning to diagnose Parkinson disease: is it cost-effective?

A recent study has concluded that the use of (123)I-2 beta-carbomethoxy-3beta-(4-iodophenyl)-N-(3-fluoropropyl)nortropane single-photon emission computed tomography ((123)I-FP-CIT SPECT) is cost-effective or cost-saving in patients in whom the diagnosis of Parkinson disease versus essential tremor is uncertain. This conclusion is based on numerous assumptions, not all of which are likely to be universally applicable. The economic advantages associated with the use of (123)I-FP-CIT SPECT will vary depending on the prevalence of Parkinson disease in the group of patients with uncertain diagnosis, the cost of usual clinical evaluation including other diagnostic tests, and the consequences of either delaying or inappropriately instituting dopaminergic therapy. The cost-effectiveness of radionuclide scanning is likely to increase in the future if a therapy is developed with a convincing impact on disease progression, the early institution of which confers a better outcome.