CMS must remove, not build, barriers to PET use for Alzheimer's

The Centers for Medicare & Medicaid Services currently is finalizing a decision on coverage for beta amyloid imaging. In a proposed decision released in July, CMS stated that there is insufficient evidence that the scan will improve health outcomes for patients with dementia or other neurodegenerative diseases.

That proposed decision memo was met with dismay by a number of organizations--including the Society of Nuclear Medicine and Molecular Imaging and the Alzheimer's Association--who argued that sufficient evidence exists to support immediate coverage that "would change patient management, lead to better health outcomes for patients and assist families making care decisions."

Now, interim data from an ongoing national clinic trial--called the Metabolic Cerebral Imaging in Incipient Dementia study--shows that patients suffering from Alzheimer's who were diagnosed sooner than usual using FDG-PET imaging were able to receive Alzheimer's-specific medications earlier than other patients who didn't have the brain imaging, resulting in improved clinical outcomes.

According to the researchers, this study, presented at the Medical Biotech Forum in China on Friday, "provides the first direct evidence for improved cognitive outcomes attributable to a neuroimaging test of any kind."

As lead investigator Daniel Silverman, a professor of molecular and medical pharmacology at UCLA, pointed out, the results represent some serious implications.

For example, if a test can rule out Alzheimer's earlier, physicians can avoid prescribing drugs to a patient who doesn't have the disease. The money spent on prescribing drugs for the wrong condition would be more than the cost for the reimbursement of a PET scan, Silverman argued.

On the other hand, it could allow physicians to provide drugs to an Alzheimer's patient earlier than if he or she remained undiagnosed, therefore enabling elongated retention of some cognitive abilities. What's more, the longer an Alzheimer's patient can stay out of a nursing home, the longer his or her family can avoid paying the exorbitant costs associated with such care.

In a commentary published in August in The Hill, George Vradenburg, Howard Fillit, M.D., and Michael Weiner, M.D., wrote that Alzheimer's "presents a grave and growing threat to millions and millions of Americans and to the solvency of Medicare itself. We need to make sure patients and their doctors have all the safe and effective tools we can to fight against this threat."

I agree, and believe that CMS must act in a way that removes--rather than builds--barriers to implementing procedures and products that can help both doctors and patients better deal with Alzheimer's disease. - Mike  @FierceHealthIT

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