IBJNews

Feds mull covering Alzheimer's test that uses Lilly's Amyvid

Back to TopCommentsE-mailPrintBookmark and Share

The U.S. government is set to decide this month whether federal health insurance should cover the cost of a $3,000 test that for the first time accurately identifies the signature brain plaques of Alzheimer’s disease.

A lot is riding on the decision. Those in favor of coverage say the brain scan will reduce anguish and lower medical costs for families struggling to determine appropriate care for a relative suffering from memory loss. What’s more, the test could help create a broad base of early Alzheimer’s patients for research purposes, they say. Opponents counter that coverage would be a waste of money because Alzheimer’s remains an incurable disease and knowing whether a person has the disease is of little or no benefit.

“I wouldn’t be surprised if this decision went in either direction,” said Sean Tunis, the founder and director of the Center for Medical Technology Policy in Baltimore. “The science on this one is so early, so it’s hard to make a case from a clinical point of view that the diagnosis will make a difference. It will tilt on political dynamics more than the science.”

The test, approved last year by U.S. regulators, uses Eli Lilly and Co.’s Amyvid imaging agent to trace a brain protein linked to a disease that affects 5 million Americans, a number that patient advocates say could double by 2050. A decision in favor of coverage could also spur interest in a similar agent that General Electric Co. is developing.

Differentiating between those who suffer from Alzheimer’s and others who have lesser forms of dementia is key for determining proper treatment, said Robert Berenson, a fellow at the Urban Institute. One kind of illness frequently mistaken for Alzheimer’s is called multi-infarct dementia. For this condition, doctors can use blood thinners to keep the disease from progressing.

Memory loss can also be caused by tumors or dietary deficiencies, conditions that can be reversed before they become too damaging, said Dean Hartley, director of scientific initiatives for the Alzheimer’s Association.

“We need to make sure we can rule out Alzheimer’s,” Hartley said.

Over the last decade, attempts to develop an effective Alzheimer’s’ treatment have come up short, failing to crack an estimated $20 billion market. As a result, scientists have called for a national research effort that was recently endorsed by U.S. President Barack Obama.

Amyvid, the first drug of its kind, was approved for sale last year by U.S. regulators, and in January in Europe. It binds to beta-amyloid plaques in the brain that are a suspected cause of Alzheimer’s. The dye’s radiation allows an image to be produced using a PET scan, showing where amyloid plaques exist in the brain and how extensive they may be.

In January, after Lilly requested a determination on coverage from the Centers for Medicare and Medicaid Services, a panel of U.S. advisers said it wasn’t confident the tests would improve the health of people with Alzheimer’s. A final decision will come July 9, according to Don McLeod, an agency spokesman who declined to comment further. The agency oversees Medicare, the U.S. health program for the elderly and disabled, and Medicaid, the joint-state medical plan for the poor.

While a negative decision would limit use of the tests, approval would probably open the door for coverage by private insurers, which often follow the federal government’s lead. That would potentially result in millions of people receiving the test.

Those sorts of numbers could be especially useful for research, said Daniel Skovronsky, CEO of Lilly’s Avid Radiopharmaceuticals unit. Currently, scientists must scan each patient they recruit for Alzheimer’s trials to determine if they have the disease, according to Skovronsky. About a third of patients don’t and those scans are thrown away, wasting time and money.

“If it’s reimbursed already, then there will be people already pre-sorted,” Skovronsky said. “Most trials want to know the amyloid status of patients but, because it’s not been widely used in clinical practice, it takes time and money. That’s a drag on research.”

Deciding how such tests will be used in the future is an important issue as the Baby Boom ages. More than 60 percent of family caregivers for those with dementia rated the emotional stress of their effort as high or very high in a 2010 poll of 3,118 people in that situation, and 39 percent of caregivers suffer depression that needs to be treated, according to research published in the Journal of Clinical Epidemiology.

“You have two different emotions,” said Pamela Machado, 54, of Waterford, California. Her father, Tom Perry, was diagnosed with Alzheimer’s disease and underwent amyloid imaging. “I was happy to know what was going on, but so incredibly sad it’s confirmed. It helps prepare you, though, and you can then seek help.”
 

ADVERTISEMENT

  • other medical costs not relevent
    Whether or not money is being wasted on other medical care or drugs has nothing to do with the choice of spending $3000 for a test verses trying a better diet first.
  • There is more to the test
    This test needs to be covered. Can you imagine how much money is wasted on medications that are unnecessary simply because a doctor has nothing else to do for the patient? Needless dollars spent by government, insurance companies and patients all because a doctor is scared (or embarrassed) to say "I have nothing I can do for you". When in fact they do have ways to change the course of someones life. How many people are simply left to die because a doctor thinks they are dealing with dementia and, as the article states, they are actually dealing with a patient who has multi-infarct dementia or a myriad of other causes of their dementia? Why not provide these patients and their doctors with information that may allow someone to stop the advancement of their disease? At a minimum, if the test is positive, a patient and their family can plan for what is about to come and hope for something to come around that will salvage what memories they can. In 2000–2004, cigarette smoking cost more than $193 billion (i.e., $97 billion in lost productivity plus $96 billion in health care expenditures)....costs brought on by a persons choice to smoke. Victims of Alzheimer's dont have a choice. Why deprive them of any answer that may change their life or provide information that can help family members and care givers in the last years of that life?
    • good diet
      "Memory loss can also be caused by tumors or dietary deficiencies, conditions that can be reversed before they become too damaging, said Dean Hartley, director of scientific initiatives for the Alzheimer’s Association." Before spending $3000 on a test, why not try feeding the patient a decent diet for a couple weeks? All the test does is identify if the memory loss is caused by Alzheimers.

    Post a comment to this story

    COMMENTS POLICY
    We reserve the right to remove any post that we feel is obscene, profane, vulgar, racist, sexually explicit, abusive, or hateful.
     
    You are legally responsible for what you post and your anonymity is not guaranteed.
     
    Posts that insult, defame, threaten, harass or abuse other readers or people mentioned in IBJ editorial content are also subject to removal. Please respect the privacy of individuals and refrain from posting personal information.
     
    No solicitations, spamming or advertisements are allowed. Readers may post links to other informational websites that are relevant to the topic at hand, but please do not link to objectionable material.
     
    We may remove messages that are unrelated to the topic, encourage illegal activity, use all capital letters or are unreadable.
     

    Messages that are flagged by readers as objectionable will be reviewed and may or may not be removed. Please do not flag a post simply because you disagree with it.

    Sponsored by
    ADVERTISEMENT

    facebook - twitter on Facebook & Twitter

    Follow on TwitterFollow IBJ on Facebook:
    Follow on TwitterFollow IBJ's Tweets on these topics:
     
    Subscribe to IBJ
    1. Liberals do not understand that marriage is not about a law or a right ... it is a rite of religous faith. Liberals want "legal" recognition of their homosexual relationship ... which is OK by me ... but it will never be classified as a marriage because marriage is a relationship between a man and a woman. You can gain / obtain legal recognition / status ... but most people will not acknowledge that 2 people of the same sex are married. It's not really possible as long as marriage is defined as one man and one woman.

    2. That second phrase, "...nor make or enforce any law which shall abridge the privileges or immunitites of citizens..." is the one. If you can't understand that you lack a fundamental understanding of the Constitution and I can't help you. You're blind with prejudice.

    3. Why do you conservatives always go to the marrying father/daughter, man/animal thing? And why should I keep my sexuality to myself? I see straights kissy facing in public all the time.

    4. I just read the XIV Amendment ... I read where no State shall deprive any person of life, liberty, or property ... nor make or enforce any law which shall abridge the privileges or immunitites of citizens ... I didn't see anything in it regarding the re-definition of marriage.

    5. I worked for Community Health Network and the reason that senior leadership left is because they were not in agreement with the way the hospital was being ran, how employees were being treated, and most of all how the focus on patient care was nothing more than a poster to stand behind. Hiring these analyst to come out and tell people who have done the job for years that it is all being done wrong now...hint, hint, get rid of employees by calling it "restructuring" is a cheap and easy way out of taking ownership. Indiana is an "at-will" state, so there doesn't have to be a "reason" for dismissal of employment. I have seen former employees that went through this process lose their homes, cars, faith...it is very disturbing. The patient's as well have seen less than disireable care. It all comes full circle.

    ADVERTISEMENT