INVESTIGATING THE COST-EFFECTIVENESS OF COMBINED COGNITIVE TEST, GUT MICROBIOTA SCREENING, AND LECANEMAB TREATMENT FOR EARLY ALZHEIMER'S DISEASE IN CHINA
Author(s)
Lei Zhang, PhD;
Monash University, Professor, Melbourne, Australia
Monash University, Professor, Melbourne, Australia
OBJECTIVES: Gut microbiota (GM) biomarkers offer a promising, non-invasive approach for early Alzheimer’s disease (AD) screening, and the recent approval of lecanemab has renewed optimism for early treatment in older adults (aged ≥60 years). We investigate the population impact and cost-effectiveness of the optimal integration of GM-based screening and lecanemab treatment for AD care.
METHODS: A decision tree-Markov model was developed to assess the cost-effectiveness of combined AD screening and treatment strategies in Chinese older adults, from a societal perspective. The model simulated AD progression in a cohort of 100,000 individuals, with no screening plus standard of care (SOC) as the reference. The cohort was followed to age 80 years, using a willingness-to-pay threshold of three times the Chinese Gross Domestic Product per capita (US$38,043 in 2023). Costs and quality-adjusted life-years (QALYs) were discounted at 3% annually. Incremental cost-effectiveness ratios (ICERs) identified optimal strategies. Deterministic and probabilistic sensitivity analyses (PSA) tested the robustness, and scenario analyses examined lecanemab pricing effects.
RESULTS: The status quo would yield AD-related costs of US$737 million, 1.027 million QALYs, and 23,140 projected severe AD cases over the lifetime of the cohort. The most cost-effective strategy was annual screening from age 60 using combined Montreal Cognitive Assessment and GM screening with SOC treatment (MoCA+GM+SOC), costing US$74.54 million more than the next-best strategy but gaining 3,729 QALYs (ICER=US$19,990/QALY). This strategy would prevent 7,854 severe AD cases versus the status quo and has a 77.2% probability of being cost-effective in PSA. Replacing SOC with lecanemab was not cost-effective unless the drug price decreased from US$356 to US$10 per vial (97% reduction).
CONCLUSIONS: Annual screening from age 60 combining MoCA and GM biomarkers is likely cost-effective for early AD detection and management in China. Substantial price reductions are required for lecanemab-based strategies to achieve cost-effectiveness.
METHODS: A decision tree-Markov model was developed to assess the cost-effectiveness of combined AD screening and treatment strategies in Chinese older adults, from a societal perspective. The model simulated AD progression in a cohort of 100,000 individuals, with no screening plus standard of care (SOC) as the reference. The cohort was followed to age 80 years, using a willingness-to-pay threshold of three times the Chinese Gross Domestic Product per capita (US$38,043 in 2023). Costs and quality-adjusted life-years (QALYs) were discounted at 3% annually. Incremental cost-effectiveness ratios (ICERs) identified optimal strategies. Deterministic and probabilistic sensitivity analyses (PSA) tested the robustness, and scenario analyses examined lecanemab pricing effects.
RESULTS: The status quo would yield AD-related costs of US$737 million, 1.027 million QALYs, and 23,140 projected severe AD cases over the lifetime of the cohort. The most cost-effective strategy was annual screening from age 60 using combined Montreal Cognitive Assessment and GM screening with SOC treatment (MoCA+GM+SOC), costing US$74.54 million more than the next-best strategy but gaining 3,729 QALYs (ICER=US$19,990/QALY). This strategy would prevent 7,854 severe AD cases versus the status quo and has a 77.2% probability of being cost-effective in PSA. Replacing SOC with lecanemab was not cost-effective unless the drug price decreased from US$356 to US$10 per vial (97% reduction).
CONCLUSIONS: Annual screening from age 60 combining MoCA and GM biomarkers is likely cost-effective for early AD detection and management in China. Substantial price reductions are required for lecanemab-based strategies to achieve cost-effectiveness.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HTA4
Topic
Health Technology Assessment
Disease
SDC: Neurological Disorders