Emerging Perspectives on Amyloid PET Imaging for Alzheimer's Disease

While amyloid positron emission tomography (PET) was originally viewed as a diagnostic test to help detect Alzheimer’s disease, Jacob Dubroff, M.D., Ph.D., said the recently issued proposal from the Centers for Medicare and Medicaid Services (CMS) to address prior Medicare coverage restrictions for this imaging “opens the opportunity” for the use of amyloid PET to assess treatment efficacy.

In a recent interview, Dr. Dubroff said amyloid PET imaging may help physicians and patients navigate a shifting ratio of benefits and risks such as amyloid-related imaging abnormalities (ARIA) during the use of anti-amyloid therapies.

“If you already got the benefit of the drug and don’t need more treatment, it’s good to stop because you don’t want to have the risks. Risks could be more side effects, hospitalizations, and more cost. I don’t know exactly how much amyloid PET imaging will be reimbursed for but hypothetically, let’s say it’s $2,000 or $3,000. If you can prevent an admission for $20,000, that is money well spent,” noted Dr. Dubroff, the modality chief of nuclear medicine and therapy, and associate professor of radiology at the Hospital of the University of Pennsylvania.

(Editor’s note: For related content, see “CMS Proposes Lift of Coverage Restrictions on PET imaging for Alzheimer’s Disease” and “Hybrid PET/MRI Assessment with Hippocampal Radiomics May Facilitate Early Alzheimer’s Diagnosis.”)

Dr. Dubroff emphasized the amyloid PET scan represents “an elegant, well-tolerated safe test” that can be utilized for diagnosis as well as the assessment of treatment effectiveness. While noting that the CMS proposal provides hope for improved Medicare coverage of amyloid PET imaging for patients with Alzheimer’s disease, Dr. Dubroff said balancing the benefits and risks with the considerable costs of anti-amyloid therapies and imaging will be a challenging conundrum.

“If you open the floodgates and allow all the testing and all the treatment, that is going to be a lot of money,” noted Dr. Dubroff. “How do we do this in a way that makes sense where we can get the most benefit out of imaging and the drug?”

For more insights from Dr. Dubroff, watch the video below.