Cost-Effectiveness of Delaying Progression of Alzheimer's Disease with Novel Monoclonal Antibodies: A Societal Perspective
Author(s)
Minseon V. Chung, PharmD, MPH1, Manasi Datar, PhD2, Sean D. Sullivan, PhD1.
1The CHOICE Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA, 2HEOR Evidence Strategy and Synthesis, Novo Nordisk, Plainsboro, NJ, USA.
1The CHOICE Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA, 2HEOR Evidence Strategy and Synthesis, Novo Nordisk, Plainsboro, NJ, USA.
Presentation Documents
OBJECTIVES: The national total cost for elderly individuals with Alzheimer’s Disease (AD) has been rising steadily in the US. Since 2021, three novel monoclonal antibodies have entered the US market as disease-modifying treatments for AD. This research aims to estimate the cost impact and cost-effectiveness of Aducanumab, Donanemab, and Lecanemab in delaying progression in early AD patients.
METHODS: A Markov simulation model was used incorporating literature and a prior cost-impact model of delaying AD progression. The clinical benefit and cohort’s characteristics mirrored results from phase 3 clinical trials of the three agents. The price of the agents was estimated using wholesale acquisition costs published by Micromedex® RED BOOK®. The model used a 1-week cycle length and estimated 10-year cost impact and incremental cost-effectiveness ratios (ICERs) relative to the standard of care (SOC). Results were described from a societal perspective, which considered patients’ and care partners’ healthcare costs, out-of-pocket costs and productivity. One-way sensitivity analyses were conducted with results presented in tornado diagrams ranking the most influential factors.
RESULTS: The three agents were estimated to delay progression to severe AD by 2.3-19 weeks. The analysis showed that SOC costs $911K over 10 years. Donanemab added $60K, and Aducanumab and Lecanemab added $45K and $54K to the cumulative costs, respectively. Donanemab had the highest ICER at $193K/QALY, followed by Aducanumab at $160K/QALY and Lecanemab at $130K/QALY. Sensitivity analyses indicated age at initiation of the treatment and treatment costs were the most influential factors across all treatments.
CONCLUSIONS: New monoclonal AD treatments were estimated to add substantial costs with modest clinical benefits, with Donanemab adding the highest cost. The cost-effectiveness of the agents is substantially influenced by the patient’s age at treatment initiation and the cost of medications.
METHODS: A Markov simulation model was used incorporating literature and a prior cost-impact model of delaying AD progression. The clinical benefit and cohort’s characteristics mirrored results from phase 3 clinical trials of the three agents. The price of the agents was estimated using wholesale acquisition costs published by Micromedex® RED BOOK®. The model used a 1-week cycle length and estimated 10-year cost impact and incremental cost-effectiveness ratios (ICERs) relative to the standard of care (SOC). Results were described from a societal perspective, which considered patients’ and care partners’ healthcare costs, out-of-pocket costs and productivity. One-way sensitivity analyses were conducted with results presented in tornado diagrams ranking the most influential factors.
RESULTS: The three agents were estimated to delay progression to severe AD by 2.3-19 weeks. The analysis showed that SOC costs $911K over 10 years. Donanemab added $60K, and Aducanumab and Lecanemab added $45K and $54K to the cumulative costs, respectively. Donanemab had the highest ICER at $193K/QALY, followed by Aducanumab at $160K/QALY and Lecanemab at $130K/QALY. Sensitivity analyses indicated age at initiation of the treatment and treatment costs were the most influential factors across all treatments.
CONCLUSIONS: New monoclonal AD treatments were estimated to add substantial costs with modest clinical benefits, with Donanemab adding the highest cost. The cost-effectiveness of the agents is substantially influenced by the patient’s age at treatment initiation and the cost of medications.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
PT27
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
SDC: Geriatrics, SDC: Neurological Disorders