Evaluating Early Dementia With and Without Assessment of Regional Cerebral Metabolism by PET: A Comparison of Predicted Costs and Benefits

Evaluating Early Dementia With and Without Assessment of Regional Cerebral Metabolism by PET: A Comparison of Predicted Costs and Benefits

Daniel H.S. Silverman, MD, PhD¹, Sanjiv S. Gambhir, MD, PhD¹^,2, Hsuan-Wen C. Huang, BSc¹, Judy Schwimmer, MS, MBA², Shanna Kim¹, Gary W. Small, MD¹^,3^,4, Joshua Chodosh, MD⁴, Johannes Czernin, MD¹ and Michael E. Phelps, PhD¹^,2

¹ Department of Molecular and Medical Pharmacology and Ahmanson Biological Imaging Center, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California
² Department of Biomathematics and Crump Institute for Molecular Imaging, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California
³ Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California
⁴ Department of Internal Medicine and Center on Aging, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, California

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FIGURE 1. Conventional algorithm used for diagnosis of AD. H & P = history and physical examination; exam = examination; o/w = otherwise; abnl = abnormal; bleed = bleeding; CNS = central nervous system; LP = lumbar puncture; E E G = electroencephalogram; ESR = erythrocyte sedimentation rate; U/A = urinalysis; CXR = chest x-ray; Tox = toxicology; NEG = negative; POS = positive; Labs = laboratory tests.

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FIGURE 2. Proposed guidelines for determining when to obtain brain PET study in evaluation of geriatric patients with early symptoms of cognitive decline. H & P = history and physical examination; exam = examination; o/w = otherwise; bleed = bleeding; neurol. = neurologic; neurosurg. = neurosurgical; consult = consultation; NEG = negative; POS = positive; Labs = laboratory tests; ID = infectious disease; Endocrin. = endocrinology; Psych = psychology.

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FIGURE 3. Effect of cost of PET on cost savings achieved with proposed algorithm. Arrow indicates PET cost ($1,661) for base case.

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FIGURE 4. Effects of varying sensitivity (top) and specificity (bottom) of PET on cost savings achieved with proposed algorithm. Vertical dashed lines indicate sensitivity and specificity values.

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FIGURE 5. Effect of cost of added AD-related care on cost savings achieved with proposed algorithm. Vertical dashed line indicates cost of added AD care established for base-case analysis.