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Medicare Panel Says Alzheimer’s Brain Scans May Not Help

January 30, 2013

Medicare Panel Says Alzheimer’s Brain Scan Not Sure to Help

A woman who suffers from Alzheimer's desease, looks at an old picture in a retirement home. Photographer: Sebastien Bozon/AFP/Getty Images

Advanced brain scans to detect signs of Alzheimer’s disease may be denied coverage by Medicare after a U.S. advisory panel said it isn’t confident the tests will improve the health of people in the program.

The panel voted today at a meeting in Baltimore that it had low to intermediate confidence in improved health outcomes from PET scans meant to show telltale plaques in the brains of Alzheimer’s patients. The Centers for Medicare and Medicaid Services has been weighing whether to begin paying for the scans, which use Eli Lilly & Co. (LLY:US)’s drug Amyvid, or florbetapir, and can cost as much as $3,000 each.

The Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging are urging Medicare, the $560 billion U.S. health-insurance program for the elderly and disabled, to cover the procedure. Doctors at the meeting said the scans can give patients greater certainty about their conditions, while critics said the technology hasn’t been sufficiently vetted.

“There’s never been a study that asked whether patients do better as a result of florbetapir testing,” said David Kuhlmann, a neurologist at Bothwell Regional Health Center in Sedalia, Missouri.

Howard Fillit, executive director of the Alzheimer’s Drug Discovery Foundation in New York, argued for coverage of the scan and told the panel about a 59-year-old patient he treated who appeared to have the disease and couldn’t afford the procedure.

“She was forced to resign from work,” he said. “Her life is in limbo while she waits for a definitive diagnosis from the test of time.”

Brain Plaque

Lilly urged Medicare to cover the scans despite the advisory panel’s vote. It’s the first test that can reveal amyloid plaques in the brains of living Alzheimer’s patients, and doctors say the procedure can change their diagnoses and treatment plans, Wei-Li Shao, senior director of the Alzheimer’s business at the Indianapolis-based company, said in a phone interview.

“Good information is the cornerstone of a good diagnosis,” he said. “Lilly is firmly resolved and remains steadfast in its belief that this technology should be available to Medicare beneficiaries.”

PET scans require a drug injected into patients to highlight brain plaque for doctors. Lilly’s Amyvid is the only compound currently approved for use with PET scans for this purpose.

Alzheimer’s, the most-common form of dementia, is the sixth-leading cause of death in the U.S., according to the Alzheimer’s Association. The number of people with the disease is expected to double within 20 years as the world’s population ages, to as many as 65.7 million people in 2030 and 115 million by 2050, the World Health Organization said in April.

There is no treatment to cure or slow the disease. Current therapies address only symptoms.

To contact the reporter on this story: Alex Wayne in Washington at awayne3@bloomberg.net

To contact the editor responsible for this story: Reg Gale at rgale5@bloomberg.net


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