title: Cost-effectiveness of magnetic resonance imaging with a new contrast agent for the early diagnosis of Alzheimer's disease.
abstract: BACKGROUND
  Used as contrast agents for brain magnetic resonance imaging (MRI), markers for beta-amyloid deposits might allow early diagnosis of Alzheimer's disease (AD). We evaluated the cost-effectiveness of such a diagnostic test, MRI+CLP (contrastophore-linker-pharmacophore), should it become clinically available.
  
  
  RESULTS
  We compared the cost-effectiveness of MRI+CLP to that of standard diagnosis using currently available cognition tests and of standard MRI, and investigated the impact of a hypothetical treatment efficient in early AD. The primary analysis was based on the current French context for 70-year-old patients with Mild Cognitive Impairment (MCI). In alternative "screen and treat" scenarios, we analyzed the consequences of systematic screenings of over-60 individuals (either population-wide or restricted to the ApoE4 genotype population). We used a Markov model of AD progression; model parameters, as well as incurred costs and quality-of-life weights in France were taken from the literature. We performed univariate and probabilistic multivariate sensitivity analyses. The base-case preferred strategy was the standard MRI diagnosis strategy. In the primary analysis however, MRI+CLP could become the preferred strategy under a wide array of scenarios involving lower cost and/or higher sensitivity or specificity. By contrast, in the "screen and treat" analyses, the probability of MRI+CLP becoming the preferred strategy remained lower than 5%.
  
  
  CONCLUSIONS
  It is thought that anti-beta-amyloid compounds might halt the development of dementia in early stage patients. This study suggests that, even should such treatments become available, systematically screening the over-60 population for AD would only become cost-effective with highly specific tests able to diagnose early stages of the disease. However, offering a new diagnostic test based on beta-amyloid markers to elderly patients with MCI might prove cost-effective.
authors.affiliation: Laboratoire Modélisation et Surveillance des risques sanitaires - Conservatoire national des Arts et Métiers - 75003, Paris, France.
authors.forename: Maria
authors.initials: M
authors.lastname: Biasutti
authors.forename: Natacha
authors.initials: N
authors.lastname: Dufour
authors.forename: Clotilde
authors.initials: C
authors.lastname: Ferroud
authors.forename: William
authors.initials: W
authors.lastname: Dab
authors.forename: Laura
authors.initials: L
authors.lastname: Temime
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis* / Q000191:economics; D060825:Cognitive Dysfunction / Q000175:diagnosis* / Q000191:economics; D003287:Contrast Media / Q000191:economics*; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D005602:France; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000379:methods; D008297:Male; D008875:Middle Aged
chemical_list: D003287:Contrast Media