WASHINGTON DC – JUNE 20, 2023 Jay Reinstein, who suffers from Alzheimer’s, prepares to obtain a … [+]
Final yr, Medicare decided it would routinely pay for sophisticated imaging tests for Alzheimer’s illness referred to as amyloid-PET (positron emission tomography) scans. The transfer will make it simpler for individuals with early-stage reminiscence loss to get examined and doubtlessly grow to be eligible for a category of latest medication that intention to sluggish the development of Alzheimer’s.
Nevertheless, many neuroscientists and imaging consultants query whether or not amyloid PET can precisely establish early-stage Alzheimer’s or measure the advantages of those new medication. Till now, Medicare paid for just one amyloid-PET scan over a affected person’s’ lifetime, reflecting uncertainty about its worth.
The brand new medication, corresponding to Leqembi, deal with early-stage Alzheimer’s solely, not any of the handfuls of different types of dementia. An incorrect analysis means individuals might obtain the expensive remedy even when they don’t have Alzheimer’s, thus getting no profit and risking harmful unwanted effects.
Prices And Questions
It additionally means Medicare and shoppers might spend billions of {dollars} on unreliable testing and ineffective and dangerous medication. Every PET scan prices Medicare between about $700 and $1,200, and people being handled with the brand new medication will want ongoing assessments. A Medicare beneficiary’s value for every check is about $300. An uninsured affected person can anticipate to pay as much as $3,000.
The annual value of Leqembi itself is about $26,500. Whereas Medicare pays many of the value, beneficiaries should pay 20 %, or about $5,000.
Alternate options
Some consultants, corresponding to Poul F. Høilund-Carlsen of Denmark’s Odense College Hospital, say a different kind of PET scan, called an FDG-PET, may be a more accurate way to establish early stage Alzheimer’s. Others suggest an older check, referred to as a lumbar puncture, or spinal tap, which may be a greater predictor of Alzheimer’s. However lumbar punctures are invasive and may trigger complications. And even they’re imperfect diagnostic instruments.
Researchers are exploring many options. Some are learning whether or not they can use spinal faucets to establish different Alzheimer’s biomarkers. Others try to develop new blood tests that more directly identify symptoms of Alzheimer’s, corresponding to damaged connections between mind cells. Or ways to image both AB and other brain material to higher establish Alzheimer’s. Another group is looking on the worth of a multi-day on-line cognitive check. However most options stay experimental.
As a result of the brand new medication are focused solely to these with early-stage Alzheimer’s or cognitive impairment that’s anticipated to result in Alzheimer’s, it’s important {that a} affected person’s illness be appropriately recognized. Many researchers imagine that Alzheimer’s is related ultimately with larger ranges of a protein referred to as Amyloid beta, or AB. They are saying in case you discover excessive ranges of AB in sufferers’ brains, you could be certain they’ve Alzheimer’s illness, even when they present no signs.
A Crude Proxy
However the scans can’t see Alzheimer’s in the identical manner an X-Ray reveals a damaged bone. As an alternative, they measure AB and typically a associated protein referred to as tau. However many people with high levels of AB in their brains never will have symptoms of Alzheimer’s. And lots of with the illness don’t have uncommon ranges of AB. Thus, testing for these proteins could also be solely a crude proxy for Alzheimer’s.
This form of oblique diagnostic check is way more difficult, particularly in an organ as sophisticated and poorly understood because the mind. As one imaging skilled advised me, testing for AB is “essential however not ample” to diagnose Alzheimer’s.
Utilizing AB as a proxy for Alzheimer’s creates a second downside. Whereas new medication corresponding to Leqembi do clear AB from the mind, they solely modestly sluggish development of the illness. That raises extra questions on each the medication and amyloid-PET which, in spite of everything, measures amyloid however not mind operate.
Critics say the third downside is that that amyloid-PET primarily identifies adjustments in components of the mind not affected by early-stage Alzheimer’s, elevating extra questions on its advantages.
Advantages, However For Whom?
FDG-PET scans might extra precisely establish adjustments within the mind that have an effect on a affected person’s means to operate. These scans are utilized in some developed international locations to assist establish Alzheimer’s. However whereas Medicare now pays for a number of amyloid PET scans for Alzheimer’s and whereas FDG-PET is commonly used to trace other diseases including some cancers, the check typically will not be used within the US to diagnose Alzheimer’s.
One other downside: Sheena Shipley at the University of Colorado and colleagues found that physicians often misread the outcomes of PET scans and diagnose Alzheimer’s that isn’t there.
Medicare’s resolution to open the door to amyloid-PET scans virtually actually will lead to extra sufferers being identified with Alzheimer’s and receiving these medication. That shall be good for clinics with PET scanners, for drugmakers, and, maybe, for some sufferers. But it surely additionally will value taxpayers billions of {dollars} with unsure advantages for a lot of different sufferers.
