An article from Neurology Today discusses the recent meeting of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) in which the panel voted that the evidence is inadequate to demonstrate that beta amyloid PET imaging improves Alzheimer outcomes.

The article also highlights the findings from a recent white paper completed by ICER evaluating the diagnostic value and clinical benefits of testing for Alzheimer's Disease that Steve presented to MEDCAC. The purpose of the white paper was to help inform future research so that it is possible to evaluate different tests for Alzheimer's disease in a way that will generate “adequate” evidence for not only patients and clinicians, but for insurers as well. 

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Dr. Susannah L. Rose, PCORT alumna, was part of a collaborative team to examine how clinical-trial funding effects the interpretation of trial results by physicians.  Currently, all major clinical trials now include disclosures detailing who funded the study to ensure transparency. However, is it possible that this transparency is actually hurting research? One might assume that the methodological rigor of the study matters to physicians more than the disclosure.  However, in a new study, researchers at have found that pharmaceutical industry sponsorship of a research study negatively influences physicians’ perceptions of the study and their willingness to believe and act on the research findings. This study was published in the September 20, 2012 issue of the New England Journal of Medicine (NEJM).

A recent study by ITA investigators led by Amy Knudsen, PhD suggests that it may be reasonable to rescreen for colorectal cancer with methods other than colonoscopy following an initial negative exam. Using a microsimulation model of colorectal cancer, researchers found that rescreening at age 60 with colonoscopy every 10 years, CT colonography (aka “virtual colonoscopy”) every 5 years, or fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT) every year greatly reduced the risk for colorectal cancer compared with no further screening.  All rescreening strategies provided roughly the same benefit in terms of life-years gained compared with no further screening. However, rescreening with CT colonography, FOBT, or FIT reduced the risk for complications and cost less than rescreening with colonoscopy.  The authors estimate that for every person who switches to FOBT or FIT following a negative initial colonoscopy, $450 to $495 could be saved over his or her lifetime.  On a population level, switching could lead to savings of $3 billion.  


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Dr. Steven Pearson of the Institute for Clinical and Economic Review at the ITA recently published an editorial with colleagues in the New England Journal of Medicine titled “The Ethics of Early Evidence – Preparing for a Possible Breakthrough in Alzheimer’s Disease.”  Researchers recently demonstrated the drug bexarotene is effective in treating Alzheimer’s disease in a mouse model with significant reversal of neural and cognitive defects.  While the results from this animal study are premature to recommend for treatment in humans, bexarotene has already been approved by the FDA for other uses such as treatment of non-Hodgkin’s lymphoma and therefore physicians could prescribe it for off-label indications.  The authors outline the ethical issues that are raised in this situation through case studies and highlight the importance of a stakeholder group to provide guidance on how to address the potential demand for this drug.