Reimbursement for dopamine transporter SPECT imaging in the United States
“Average reimbursement per study fell from $2,469 (US dollars) in 2011 to 2012 to $1,657 in 2014. CMS reduced average reimbursement by $1,148 in 2014 because of loss of radiopharmaceutical pass-through status.” (opens the source at this quote in a new tab)
“Average reimbursements from CMS versus private payors markedly differed in 2011 to 2012 at $2,266 versus $2,861, respectively, and in 2014 at $1,118 versus $3,470, respectively.” (opens the source at this quote in a new tab)
“The range of CMS payments narrowed over the two time periods from $0 to $2,254 (average $2,266 ± $452) in 2011 to 2012 to $674 to $1,621 (average $1,118 ± $119) in 2014. The range of private payor payments was larger than CMS payments during both time periods, with $0 to $8,754 (average $2,861 ± $2,054) in 2011 to 2012 and $112 to $9,675 (average $3,470 ± $1,570) in 2014.” (opens the source at this quote in a new tab)
“For example, the first 10 studies from private payors reimbursed, on average, $5,161 more per study than the first 10 CMS studies (average of $7,172 for private payors and $2,011 for CMS).” (opens the source at this quote in a new tab)
“Assuming that I-123 ioflupane cost $2,000, our model based on 2014 data predicts a practice with greater than 60% CMS patients would no longer recover radiopharmaceutical costs.” (opens the source at this quote in a new tab)
Payer mix and reimbursement per dopamine transporter SPECT study by payer and period
Imaging setting, study volume, and limitations of the reimbursement analysis
Pass-through status, scanner location, and break-even radiopharmaceutical cost
Cost-effectiveness of dopamine transporter SPECT in suspected Parkinson's disease, Germany
“Compared strategies were CE only (EXAM+), SPECT only (SPECT+), SPECT following negative CE (SINGLE+), and SPECT following positive CE (DOUBLE+).” (opens the source at this quote in a new tab)
“Costs of SPECT amounted to €789 per investigation.” (opens the source at this quote in a new tab)
“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.” (opens the source at this quote in a new tab)
“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.” (opens the source at this quote in a new tab)
“If the decision-maker is not willing to spend approximately €733 for the equivalent of a patient-month with adequate treatment, the diagnostic work-up should include only a clinical examination.” (opens the source at this quote in a new tab)
“SPECT should be used as a confirmatory test before treatment initiation and limited to patients with a positive test result in the clinical examination.” (opens the source at this quote in a new tab)
Decision model structure, perspective, and treatment costs, Germany
“We developed a decision tree model for several diagnostic work-up strategies to determine diagnostic, therapeutic, and economic outcomes in patients with symptoms of PD who present to a specialized movement disorder outpatient clinic.” (opens the source at this quote in a new tab)
“We assumed that the correct diagnosis (PD or not) will be available in all patients after 12 months, and therefore chose a time horizon of 12 months.” (opens the source at this quote in a new tab)
“We considered that only patients in Hoehn and Yahr (HY) stage I or II would be examined.” (opens the source at this quote in a new tab)
“In the model, we counted how many months during the 1-year time horizon each individual was treated appropriately, that is, the number of months a patient with PD received antiparkinsonian therapy or the number of months an individual without PD did not receive such treatment.” (opens the source at this quote in a new tab)
“The consequence ratio ranged from 5 to 12, with a mean of 8.5.” (opens the source at this quote in a new tab)
“Economic outcomes included the cost for diagnostic procedures and PD treatment costs. All costs were based on 2002 values. We adopted the perspective of the health care provider.” (opens the source at this quote in a new tab)
“1 full year of PD treatment is associated with medication costs of €1,535 or €128 per patient-month. Including initial and follow-up clinical examinations but assuming no SPECT investigation increases the 1-year health care costs to a total of €1,689, which translates to an average of €141 per patient month.” (opens the source at this quote in a new tab)
Model inputs, SPECT cost components, and ranges tested in sensitivity analyses
Base-case expected cost, effectiveness, and ICER by diagnostic strategy
One-way sensitivity analyses, SPECT after positive clinical examination versus clinical examination only
Cost of SPECT after positive clinical examination that is inconsistent with its ICER at a SPECT sensitivity of 1.00
Interpretation of the incremental gain and limitations of the decision model
“Although DOUBLE+ was more expensive than EXAM+, DOUBLE+ also yielded between 0.23 and 6.91 additional ATMEs with ICERs varying from €63 to €2,411 per ATME, depending on the parameters varied in the sensitivity analyses. Only for consequence ratios smaller than 1.2, which was outside of the expert’s range, EXAM+ was more effective than DOUBLE+. The ICER of DOUBLE+ compared to EXAM+ improved (i.e., decreased) with decreasing prevalence of PD, decreasing accuracy of clinical examination, increasing accuracy of SPECT, and increasing consequence ratio.” (opens the source at this quote in a new tab)
“This strategy remains more expensive than clinical examination only: the expected clinical gain was 0.55 ATMEs and the additional average costs were €406 for each patient of the target population (including those after negative clinical examination).” (opens the source at this quote in a new tab)
“This result represents either assigning 17 additional days of treatment to a patient with PD or withholding about 2 additional days (i.e., 17 divided by 8.5) of treatment and side effects from a patient without PD.” (opens the source at this quote in a new tab)
“However, as in all diagnostic studies, the optimal test strategy depends on the pretest probability of the disease, in this case the prevalence of PD.” (opens the source at this quote in a new tab)
“Increasing PD prevalence to 74%, which may not be entirely unlikely for a highly specialized movement disorder clinic, leads to an ICER of more than €2,400 per ATME.” (opens the source at this quote in a new tab)
“As data were lacking on health-related quality of life indices (utilities) in early treated and nontreated patients with and without PD, we were unable to convert this outcome into QALYs, which was suggested for the reference case of a cost–effectiveness analyses.” (opens the source at this quote in a new tab)
“Hence, our analysis may be biased against SPECT and overestimating the true cost–effectiveness ratios of this technology.” (opens the source at this quote in a new tab)
“Third, we did not consider other types of parkinsonian syndromes such as multisystem atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal ganglionic degeneration (CBGD), or Lewy body disease in our decision analysis.” (opens the source at this quote in a new tab)
“Fifth, it must be kept in mind that the results of this study are limited to a specialized movement disorder clinic.” (opens the source at this quote in a new tab)
Cost-effectiveness of dopamine transporter SPECT for differentiating essential tremor from Parkinson's disease, Italy
Effect of dopamine transporter SPECT on management of early probable Parkinson's disease
Cost of alpha-synuclein seed amplification assay and skin biopsy testing
No evidence found.