Clinical and cost implications of amyloid beta detection with amyloid beta positron emission tomography imaging in early Alzheimer’s disease – the case of florbetapir

Abstract

Objective: Amyloid beta (Aβ) positron emission tomography (PET) imaging helps estimate Aβ neuritic plaque density in patients with cognitive impairment who are under evaluation for Alzheimer’s disease (AD). This study aims to evaluate the cost-effectiveness of the Aβ-PET scan as an adjunct to standard diagnostic assessment for diagnosis of AD in France, using florbetapir as an example.

Methods: A state-transition probability analysis was developed adopting the French Health Technology Assessment (HTA) perspective per guidance. Parameters included test characteristics, rate of cognitive decline, treatment effect, costs, and quality of life. Additional scenarios assessed the validity of the analytical framework, including: (1) earlier evaluation/treatment; (2) cerebrospinal fluid (CSF) as a comparator; and (3) use of other diagnostic procedures. Outputs included differences in quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). All benefits and costs were discounted for time preferences. Sensitivity analyses were performed to assess the robustness of findings and key influencers of outcomes.

Results: Aβ-PET used as an adjunct to standard diagnostic assessment increased QALYs by 0.021 years and 10 year costs by €470 per patient. The ICER was €21,888 per QALY gained compared to standard diagnostic assessment alone. When compared with CSF, Aβ-PET costs €24,084 per QALY gained. In other scenarios, Aβ-PET was consistently cost-effective relative to the commonly used affordability threshold (€40,000 per QALY). Over 95% of simulations in the sensitivity analysis were cost-effective.

Conclusion: Aβ-PET is projected to affordably increase QALYs from the French HTA perspective per guidance over a range of clinical scenarios, comparators, and input parameters.

Keywords:

• Alzheimer disease
• amyloid beta peptides
• cost–benefit analysis
• diagnosis
• diagnostic imaging
• positron-emission tomography

Note

Transparency

Declaration of funding

The project was funded by Eli Lilly and Company.

In accordance with Taylor & Francis policy and my ethical obligation as a researcher, I am reporting that I am an independent research consultant to a company that may be affected by the research reported in the enclosed paper. I have disclosed those interests fully to Taylor & Francis, and I have in place an approved plan for managing any potential conflicts arising from that involvement.

Author contributions: All authors (J.H., J.B., I.W., J.J., and M.H.) have given final approval of the version to be published, and agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

J.B., I.W., J.J., and M.H. have disclosed that they are employed by the sponsor. J.H. has disclosed that he is employed by Cedar Associates LLC, an independent research-consulting firm retained by the sponsor.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors sincerely appreciate Haya Ascher-Svanum’s critical input on the analytical framework, literature retrieval, and assessment of data sources for parameter values.

Notes

1 Amyvid is a trade name of Eli Lilly and Company, Indianapolis, IN, USA.