Costs Accrued to Conventional (C) and Proposed (P) Algorithms
| Algorithm | Item | Cost of item in base-case analysis | Medicare rate or other cost basis |
|---|---|---|---|
| C, P | H&P | ||
| Initial comprehensive | $149.47 | Medicare | |
| C | Follow-up (used to reassess for dementia in previously nondemented patient) | $62.33 | Medicare |
| C, P | Focused follow-up (used after treatment of abnormality found on H&P or laboratory tests) | $38.36 | Medicare |
| C, P | MRI | Medicare | |
| Without contrast | $608.12 | ||
| With and without contrast | $1,294.17 | ||
| C | Neuropsychologic testing | $84.33 | Medicare |
| C, P | Laboratory tests | Medicare | |
| CBC | $4.76 | ||
| ESR | $3.73 | ||
| T4 | $8.95 | ||
| TSH | $23.21 | ||
| Basic metabolic panel | $11.70 | ||
| Hepatic panel | $11.29 | ||
| Folate (RBC, serum) | $44.25 | ||
| Vitamin B12 level | $20.83 | ||
| Syphilis serology | $11.40 | ||
| P | Brain PET | $1,661 | Medicare × private insurance ratio, brain to whole body |
| C, P | Extra care needed for AD patient who progresses past early stage while going untreated because of false-negative diagnosis | $30,000 | $40,000/y of care (51) × 0.75-y (minimum) average delay of progression with therapy (16,19,26,28–31) |
| C, P | 1-y supply of cholinesterase inhibitor unnecessarily prescribed to Non-AD patient because of false-positive diagnosis | $1,500 | Median cost for donepezil and rivastigmine (most common inhibitors in current use) based on survey of local pharmacies |
H&P = history and physical examination; CBC = complete blood count; ESR = erythrocyte sedimentation rate; T4 = thyroxine (l-3,5,3′,5′-tetraiodothyronine); TSH = thyroid-stimulating hormone; RBC = red blood cell; Ref. = reference; Non-AD = no AD identified on neuropathologic examination.
Costs were based on Medicare outpatient reimbursement rates whenever possible. Costs include professional and technical components, where applicable, as listed in the 2001 Medicare Fee Schedule booklet.