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Study Nudges Medicare On Alzheimer’s Scans

September 26, 2013
Written by: , Filed in: Diagnostic Imaging, Neuroradiology
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Early diagnosis of Alzheimer’s disease via brain imaging, leading to early treatment, yields significantly better clinical outcomes over a period of years.

That seems like common sense, but of course common sense often turns out to be wrong. This time, however, preliminary results from the ongoing Metabolic Cerebral Imaging in Incipient Dementia study do indicate that the sooner the brain scan, the better for patients exhibiting signs of cognitive decline.

The interim findings, presented today at the Medicinal Biotech Forum in China, may directly affect a decision expected October 1 from the Centers for Medicare and Medicaid Services (CMS) about whether Medicare will cover such scans.

CMS is sponsoring the study, which currently includes 710 subjects, 65 or older, who exhibit signs of cognitive decline or personality change. The interim results derive from 63 patients who received a baseline PET scan performed with the FDG tracer. Patients whose physicians had access to the results of the scan did better than those whose physicians were, by randomized study design, not given the results of the scan.

Daniel Silverman, MD, PhD, the study’s principal investigator, said:

During the subsequent two years after their PET scans, these patients had superior executive function, better memory abilities, and greater preservation of overall cognitive function.

Dr. Silverman is a professor of molecular and medical pharmacology at UCLA. He was quoted in a UCLA news release.

Medicare reimburses about $1,200 for FDG-PET scans, but it does not cover PET scans for patients who show signs of cognitive decline but have not been diagnosed with dementia. Dr. Silverman said his study provides the first rigorously controlled scientific evidence that it should.

Alzheimer’s is notoriously difficult to diagnose. FDG-PET scans, which can reveal the amyloid plaques that are associated with Alzheimer’s, give doctors the knowledge they need to appropriately treat their patients, Dr. Silverman said.

Without the scans, he said, “Patients who don’t have Alzheimer’s disease may be prescribed drugs that won’t help them or even make them worse. And each year of taking these medications costs hundreds of dollars more than the reimbursement for a PET scan would.”

The study shows that appropriately treating patients who do have Alzheimer’s can moderate the course of the disease, delaying the day when they will need to enter a nursing home.

“With nursing home care costing an average of about $7,000 a month,” Dr. Silverman said, “there is the potential for CMS and American taxpayers to save several billion dollars per year.”

Related CME seminar (up to 29 AMA PRA Category 1 credits™): Neuroradiology Review


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