Cost-Effectiveness of a Hypothetical Dementia Prevention Treatment for Stroke Survivors

Author(s)

Warren S. Lament, MSc1, Luciano A. Sposato, MBA, MD2, Xiao Zhen Zhou, MD3, Kun Ping Lu, PhD, MD3, Lauren E. Cipriano, PhD1;
1Ivey Business School at Western University, London, ON, Canada, 2Schulich School of Medicine & Dentistry, Western University, Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell, London, ON, Canada, 3Schulich School of Medicine & Dentistry, Western University, Department of Biochemistry, London, ON, Canada

Presentation Documents

OBJECTIVES: Stroke survivors are at increased risk of new-onset dementia. We evaluate the cost-effectiveness of a hypothetical dementia prevention therapy in stroke survivors.
METHODS: We constructed a Markov model with one-month time steps to estimate lifetime costs and Quality Adjusted Life-Years (QALYs) associated with dementia prevention in stroke survivors. The model included 739 health states, categorized by stroke history (no stroke, minor, mild, moderate, or severe), dementia status (none, mild cognitive impairment, dementia of varying severity across cognition, behavior, and function), and living setting (community or institutional care). Transition rates, costs, and QALY weights were derived from secondary sources. For the base case, we evaluated a dementia prevention treatment priced at $35,775, consistent with the annual cost of biotherapeutics for delaying dementia in mild cognitive impairment, in a cohort of 78-year-old recent stroke survivors. Costs and benefits were discounted at 1.5% annually. The model was implemented in R (R Core Team, 2022).
RESULTS: In a cohort of 78-year-old stroke survivors, a treatment that reduced the incremental risk of dementia by 50% increased the average age of dementia onset by 0.2 to 1.5 years depending on stroke severity. At the base case price, such a treatment costs $500,000, $330,000, $150,000, and $470,000 per QALY-gained in patients who survived recent minor, mild, moderate, and severe stroke. Total treatment cost could not exceed $7,000 for mild stroke survivors and $21,000 for moderate stroke survivors to be cost-effective at a willingness-to-pay of $100,000 per QALY-gained. Short life expectancy in patients with a history of severe stroke diminished the benefits of treatment.
CONCLUSIONS: Biologic immunotherapy for post-stroke dementia prevention can be cost-effective in select populations at prices lower than current prices for dementia treatments. Achieving cost-effectiveness in most stroke survivors would require substantially lower treatment costs, even for highly-effective therapies.

Conference/Value in Health Info

2025-05, ISPOR 2025, Montréal, Quebec, CA

Value in Health, Volume 28, Issue S1

Code

EE206

Topic

Economic Evaluation

Disease

SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Neurological Disorders

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