Table 6.

Alzheimer's disease biomarker costs, adopted from [8].

Biomarker method	Patient discomfort	Risk	Est. cost per 1000 subjects, $∗	Additional considerations
Cerebrospinal fluid	Significant	Moderate to high	350,000–1,000,000	Risks include significant headache (in 40%), back or leg pain (in 11%), and rare meningitis, epidural abscess, or subdural hematoma. Requisite: skill of staff performing procedure.
Neuroimaging	Mild to moderate	Low
sMRI			400,000–800,000	Claustrophobia, need for lying still for long periods of time, expensive facility and imaging equipment, specialized staff, significant time for post hoc analysis, and variability between facilities.
fMRI			600,000–900,000
PET			1,000,000–2,000,000
SPECT			1,000,000–2,000,000
MRS			700,000–1,000,000
Blood based	Minimal	Low	40,000–100,000	Possible bruising at the site of venipuncture and vasovagal reaction.
Computerized novel screening marker	Minimal	Low	20,000–80,000†	To date, there is no single, universally accepted computerized screening system that satisfies all needs in the detection of cognitive impairment.

Abbreviations: Est., estimated; sMRI, structural magnetic resonance imaging; fMRI, functional magnetic resonance imaging; PET, positron emission tomography; SPECT, single-photon emission computed tomography; MRS, magnetic resonance spectroscopy.

^∗Cost calculations based on available online information regarding estimated individual testing charges. These are procedural charges only and do not include the costs of assays performed using cerebrospinal fluid or blood-based analyses or the personnel charges for time spent in association with imaging or fluid-based bioinformatic analyses.

^†Cost estimations per Annual Wellness Visit based on Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment in a primary care setting [41].