Clinical and cost implications of amyloid beta detection with amyloid beta positron emission tomography imaging in early Alzheimer’s disease – the case of florbetapir

Abstract

Aβ-PET is projected to affordably increase QALYs from the French HTA perspective per guidance over a range of clinical scenarios, comparators, and input parameters.

Applications of amyloid, tau, and neuroinflammation PET imaging to Alzheimer's disease and mild cognitive impairment

“…AD patients rated as Aβ positive showed a similar pattern on measures of global cognition and verbal fluency(Doraiswamy et al, 2014). When considering the clinical implementation of this modality, recent evidence demonstrates its cost-effectiveness(Hornberger, Bae, Watson, Johnston, & Happich, 2017) and meaningful impact on the diagnostic confidence for AD by physicians(Boccardi et al, 2016).While not as widely investigated as [ 18 F]florbetapir, a similar pattern of amyloid retention is demonstrated throughout the cortex in AD using both [ 18 F]florbetaben(Barthel et al, 2011) and [ 18 F] flutemetamol(Nelissen et al, 2009). When considering the clinical implementation of this modality, recent evidence demonstrates its cost-effectiveness(Hornberger, Bae, Watson, Johnston, & Happich, 2017) and meaningful impact on the diagnostic confidence for AD by physicians(Boccardi et al, 2016).While not as widely investigated as [ 18 F]florbetapir, a similar pattern of amyloid retention is demonstrated throughout the cortex in AD using both [ 18 F]florbetaben(Barthel et al, 2011) and [ 18 F] flutemetamol(Nelissen et al, 2009).…”

“…Moreover, a positive amyloid scan for MCI patients indicates a greater risk of disease progression to AD.While 18 F-labelled amyloid tracers are equivalent in their degree of diagnostic accuracy, [ 18 F]florbetapir shows particularly fast brain kinetics relative to others(Wong et al, 2010). When considering the clinical implementation of this modality, recent evidence demonstrates its cost-effectiveness(Hornberger, Bae, Watson, Johnston, & Happich, 2017) and meaningful impact on the diagnostic confidence for AD by physicians(Boccardi et al, 2016).While not as widely investigated as [ 18 F]florbetapir, a similar pattern of amyloid retention is demonstrated throughout the cortex in AD using both [ 18 F]florbetaben(Barthel et al, 2011) and [ 18 F]…”

Clinical Use and Utility of Amyloid Imaging

“…Sixteen studies concerning the clinical utility of amyloid PET imaging were found in the literature (17,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). Supplemental Table 3 summarizes these studies.…”

“…Also, in the predementia group, amyloid imaging was associated with a better outcome regarding duration of the predementia phase, caregiver time, and other parameters. Hornberger et al (43,48) performed 2 similar simulations for 18 F-florbetapir PET in Spanish and French dementia cohorts. The QALY gains by amyloid imaging (likewise as compared with a scenario without amyloid imaging) estimated in these modeling studies were 0.008 and 0.021, respectively.…”

“…Relevant parameters in this context are the cost savings by the procedure, the costs per QALY, the cost-efficiency ratio (portion of subjects in whom amyloid imaging is cost-effective based on national willingness-to-pay thresholds for one QALY), and the incremental cost-effectiveness ratio (another parameter describing the relation between the costs and the effect of amyloid imaging). The 3 previously cited model simulation studies dealing with the effect of amyloid imaging on outcome also dealt with these matters: Guo et al (36) simulated the cost effectiveness of 18 Fflorbetaben in the United States, and Hornberger et al (43,48) performed a respective modeling for 18 F-florbetapir in Spain and France. In the study of Guo et al, cost savings by amyloid imaging were estimated at $13,018 and $11,389 per subject over a lifetime in predementia and dementia subjects, respectively.…”