OBJECTIVES: Assessment of beta-amyloid plaque presence – a neuropathological hallmark of Alzheimer’s disease (AD) – can inform diagnosis and management decisions in patients with cognitive impairment. The objective was to estimate the cost-effectiveness of Positron Emission Tomography (PET) imaging with [F]Flutemetamol to determine beta-amyloid neuritic plaque presence in patients aged 40–79 years with mild cognitive impairment (MCI) or suspected dementia in Spain.

METHODS: A cost-effectiveness analysis was conducted to compare standard work-up (SWU; clinical assessment and structural imaging) plus [F]Flutemetamol-PET with SWU alone and with SWU plus cerebral spinal fluid (CSF) analysis. A Markov model was developed with health states reflecting MCI ± underlying AD, different AD severities and other dementia. It considered direct and indirect costs associated with evaluation, treatment, institutionalization and productivity loss, and compared outcomes in terms of correct diagnoses and quality-adjusted life years (QALYs) over a lifetime.

RESULTS: Addition of [F]Flutemetamol-PET achieved a higher proportion of correct diagnoses compared with SWU alone or SWU plus CSF (90.4% vs 68.7% vs 75.7%). Cost per QALY gained with addition of [F]Flutemetamol-PET was €19,017 versus SWU alone and €28,371 versus SWU plus CSF in patients aged 40–79 years. In younger patients (40–64 years) cost per QALY gained with [F]Flutemetamol-PET was €15,069 versus SWU alone and €22,647 versus SWU plus CSF. Considering only direct costs, cost per QALY gained with [F]Flutemetamol-PET versus SWU alone and versus SWU plus CSF were €39,735 and €58,443, respectively, in patients aged 40–79 years.

CONCLUSIONS: Compared to SWU or SWU plus CSF, SWU plus [F]Flutemetamol-PET enables optimal evaluation in a larger number of patients with MCI or suspected dementia. Additionally, according to the commonly used willingness-to-pay threshold in Spain (€30,000 per QALY), from a societal perspective [F]Flutemetamol-PET is cost-effective versus SWU and versus CSF in patients aged 40–79.