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Cost-Effectiveness of PET in the Diagnosis of Alzheimer Disease¹

¹ From the Institute for Technology Assessment, Massachusetts General Hospital, Zero Emerson Place, Suite 2H, Boston, MA 02114 (P.M.M., G.S.G.); Doctoral Program in Health Policy, Harvard University, Cambridge, Mass (P.M.M., S.S.A., E.A.S.); Program on the Economic Evaluation of Medical Technology, Harvard Center for Risk Analysis, Cambridge, Mass (S.S.A., E.A.S., P.J.N.); and Harvard School of Public Health, Boston, Mass (P.J.N., G.S.G.). P.M.M. supported in part by the National Cancer Institute grant 1 R25 CA92203-01A1 and the National Library of Medicine grant 5 T-15 LM07092. P.M.M. and G.S.G. supported in part by the U.S. Department of the Army under DAMD grant 17-99-2-9001. Received July 24, 2002; revision requested September 18; revision received September 25; accepted October 25. Address correspondence to G.S.G. (e-mail: scott@mgh-ita.org).

View larger version (22K): [in a new window]   With our base-case assumptions, the addition of either PET or computed SPECT (cSPECT) to the standard clinical examination results in a strategy that costs more but yields fewer gains in QALYs. Dynamic susceptibility-weighted contrast-enhanced (ie, functional) MR imaging (DSC-MRI), as compared with the standard examination, yields gains in effectiveness at an incremental cost-effectiveness ratio of $598,800 per QALY. When no side effects in the patients with non-AD-related dementia who are treated with donepezil hydrochloride are included in the model, the strategy of treating all patients with dementia dominates all the imaging strategies, with an incremental cost-effectiveness ratio of $141,200 per QALY.