Ruling out Alzheimer’s correctly and early could save Medicare millions

The latest diagnostic technologies, including imaging advances such as beta-amyloid PET scans of the brain, hold the promise of helping avoid misdiagnoses of Alzheimer’s disease. A new study shows the resulting savings in more appropriate utilization of resources could help Medicare steer clear of needlessly spending anywhere from $9,500 to more than $14,000 per initially misdiagnosed patient per year.

Writing in the July edition of Alzheimer’s and Dementia, several analysts from Analysis Group in Boston, together with an executive of Eli Lilli and Company in Indianapolis, describe their work looking at a 5 percent random sample of Medicare beneficiaries.

The researchers considered payments to providers for Alzheimer’s-related treatments and procedures prior to corrected diagnoses of other conditions.

They found that 8 percent of the sample group turned out to have not Alzheimer’s but Parkinson’s, while some 17 percent were later correctly diagnosed with vascular dementia (reduced flow of blood to the brain).

Between the time of the Alzheimer’s misdiagnosis and the subsequent correct diagnosis of vascular dementia, this group had, on average, 40 percent to 143 percent more inpatient days per year as compared with a matched control group.

These patients also had 45 to 79 percent more ER visits, 19 to 48 percent more outpatient/physician visits, 61 to 221 percent more visits to skilled nursing facilities and up to 44 percent more claims for durable medical equipment.

“[T]his type of excess medical service use disappears once a correct diagnosis is achieved,” the authors write, adding that the adjustment “provides further evidence of the relationship between accurate diagnosis and improved patient outcomes.”

The crunched numbers on the high cost of Alzheimer’s misdiagnoses add “clarity and understanding to the role that timely and accurate dementia diagnoses can play in patients’ lives,” they conclude, “while potentially providing substantial savings within the Medicare system.”

Eli Lilly subsidiary Avid Radiopharmaceuticals markets a product used in beta-amyloid PET, Amyvid. Whle the FDA has cleared Amyvid, CMS deemed the evidence supporting the PET agent's use to be insufficient for full coverage and reimburses only a single scan for patients enrolled in clinical trials through the coverage with evidence development program.