Long-term cost-effectiveness of a more accurate diagnostic work-up for dementia

INTRODUCTION: To address uncertainty about long-term clinical and economic impacts of an accurate dementia diagnosis, we evaluated the cost-effectiveness of adding amyloid positron emission tomography (PET) to memory clinic workup over 5 years. METHODS: Inverse probability weighting was used to balance covariates between PET (n = 440) and no-PET (n = 460) participants from the Amsterdam Dementia Cohort. Time in community following diagnosis, time alive, and costs were combined in cost-effectiveness analyses. RESULTS: PET participants lived longer in community (0.26 years, 95% confidence interval [CI]: 0.05 to 0.45) and overall (0.15, CI: 0.02 to 0.27), but did not have statistically different health insurance (€703, CI: −3974 to 5045) or total costs including institutionalization (−€8258, CI: −20,622 to 3377). The probability that PET was cost-effective for extending time in community was 76% at a €2530 willingness-to-pay threshold. The probability that PET yielded cost savings and was more effective for extending time alive was 90%. DISCUSSION: Findings in this observational cohort suggest that using amyloid PET in memory clinics may be cost-effective. Highlights: Participants with an amyloid PET in a memory clinic work-up were compared to those without. The amyloid PET group spent more time in community and alive over 5 years of follow-up. Amyloid PET had a 76% chance to cost-effectively extend time in community in uncertainty analysis.