The Cost Effectiveness of Collaborative Dementia Care for Alzheimer's Disease Relative to Disease Modifying Therapies

OBJECTIVES: Few people with AD are eligible for drug therapies, whereas collaborative dementia care models have broad clinical eligibility criteria. We estimated the lifetime health and economic outcomes of adults with dementia due to AD who receive collaborative dementia care, compared to 18 months of lecanemab. We then estimated the real-world outcomes of each intervention by scaling the estimated costs and benefits to the eligible US population.

METHODS: We modelled a simulation cohort of 1,000 people (52% female) aged 71 years at the commencement of: 1) usual care, 2) lecanemab or 3) collaborative dementia care. We applied our model outcomes to all people with dementia due to AD who were eligible. Primary outcomes were quality-adjusted-life-years (QALYs); life years (LYs); community years (CYs), and costs in US dollars.

RESULTS: Compared to usual care, per-person LYs and CYs increased by 0.18 and 0.19, respectively with lecanemab. Lifetime QALYs for lecanemab were 0.18 higher than usual care, due to disease slowing. Lifetime QALYs for collaborative dementia care were 0.36 higher than usual care, due to improved quality of life. Compared to usual care, per person CYs were 0.34 higher with collaborative dementia care; LYs did not differ. Per-person cost of lecanemab was $35,082 higher than usual care, driven by drug costs. Per-person cost of collaborative dementia care was $50,241 lower than usual care, reflecting savings to Medicare. We estimated 8% of people with AD were eligible for lecanemab whereas 92% were eligible for collaborative dementia care. The population benefit of lecanemab was 190,000 QALYs and cost $36 million. The population benefit of collaborative dementia care was 2.2 million QALYs with savings of $310 billion.

CONCLUSIONS: The QALY gains of collaborative dementia care far exceed lecanemab, with a net cost reduction. Universal access to collaborative dementia care should be a priority of health care policy in the US.