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Impact of Treatment Duration on the Potential Cost-Effectiveness of Disease-Modifying Therapies for the Treatment of Early Symptomatic Alzheimer's Disease

Speaker(s)

Boustani M1, Garrison L2, Smolen L3, Belger M4, Klein TM3, Murphy DR3, Burge RT5, Johnston J5
1Indiana University, Indianapolis, IN, USA, 2University of Washington,The Comparative Health Outcomes, Policy, and Economics Institute, Seattle, WA, USA, 3Medical Decision Modeling Inc., Indianapolis, IN, USA, 4Eli Lilly and Company, Bracknell, SRY, UK, 5Eli Lilly and Company, Indianapolis, IN, USA

Presentation Documents

OBJECTIVE: To examine potential cost-effectiveness of Alzheimer’s disease-modifying therapies (DMTs) of different treatment durations.

BACKGROUND: Clinical trial results suggest the disease-modifying impact of a new class of anti-amyloid monoclonal antibodies. Optimal treatment duration is uncertain due to limited follow-up in clinical trials. A recent economic analysis of the first such agent approved questioned the economic value of treatments that slow progression of early symptomatic Alzheimer’s disease (AD) to more advanced states. Results were highly sensitive to therapy costs, which would likely be substantially influenced by treatment duration.

METHODS: We constructed a population-based Markov state-transition simulation model to calculate the cost-effectiveness of hypothetical DMTs. Base-case assumptions were similar to those in the Institute for Clinical and Economic Review evaluation of aducanumab, including a healthcare system perspective and patient lifetime time horizon. We assumed greater treatment efficacy (30% slowing of progression from mild cognitive impairment and from mild AD states), consistent with benefits anticipated from DMTs currently under evaluation. The impact of different treatment durations and therapy costs were examined.

RESULTS: A hypothetical DMT used continuously until patients progress to severe AD had an incremental cost-effectiveness ratio (ICER) ranging from $297K/QALY to $586K/QALY as annual treatment cost varied from $28K to $56K, based on the original and subsequently reduced prices set by one manufacturer. A hypothetical DMT with similar efficacy but used for only 18 months yielded ICERs from $89K to $173K/QALY. Use of a diagnostic test (cost $4000) to identify 40% of patients who could discontinue treatment due to amyloid negativity at 6 months reduced total treatment costs by 25% and yielded ICERs from $77K/QALY to $139K/QALY. Results were sensitive to mean age, efficacy assumptions and treatment cost.

CONCLUSIONS: Efficacious Alzheimer’s DMTs used for limited durations or until amyloid plaque clearance have potential to deliver value consistent with accepted cost-effectiveness thresholds.

Code

EE263

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Neurological Disorders