Alzheimer’s brain scan coverage in doubt

WASHINGTON (AP) — A big study to help Medicare officials decide whether to start covering brain scans to check for Alzheimer’s disease missed its goals for curbing health care costs, calling into question whether the pricey tests are worth it.

The results announced Thursday are from a $100 million study of more than 25,000 Medicare recipients. It’s been closely watched by private insurers too, as the elderly population grows and more develop this most common form of dementia, which currently has no cure.

Advocates for coverage say they hope to persuade the agency that the scans still offer benefits even if they don’t save much or any money. An accurate diagnosis helps families plan for the future even if the course of the disease can’t be changed, said Dr. Gil Rabinovici of the University of California, San Francisco.

He led the study and gave results at the Alzheimer’s Association International Conference taking place online because of the coronavirus pandemic. They have not been published or reviewed by other scientists yet.

A spokesman for the Centers for Medicare and Medicaid Services said the agency considers all information on risks and benefits, and that a formal request would need to be filed to prompt reconsideration of its 2013 decision to not cover the scans except in research and special circumstances.

More than 5 million people in the United States and millions more worldwide have Alzheimer’s. The only sure way to diagnose it used to be checking the brain after death.

Recently, PET brain scans have been developed to detect signs in living patients. But they cost $4,000 to $5,000 and insurers haven’t covered them because it’s not known if they have benefits.

The study aimed to find out. It involved 12,684 people with dementia or a less severe condition called mild cognitive impairment, or MCI. They were given scans and compared to Medicare recipients who were similar in age, sex and other factors but not given scans.

Partial results from the first 4,000 participants a few years ago suggested the scans more accurately diagnosed Alzheimer’s disease and altered counseling or care in up to 60% of cases.

The study missed its goal of curbing hospitalizations by 10% in the year after the scan: Rates were 24% among those scanned versus 25% of the others.


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