Is Lecanemab Worth the Wait? Real Option Value and the Cost of Future Innovation in Alzheimer's Disease
Author(s)
Juliana Paiva1, Kevin D. Davina Frick, PhD2, Emmanuel Fulgence Drabo, PhD3.
1Baltimore, MD, USA, 2Johns Hopkins Carey Business School, Baltimore, MD, USA, 3Johns Hopkins University, Baltimore, MD, USA.
1Baltimore, MD, USA, 2Johns Hopkins Carey Business School, Baltimore, MD, USA, 3Johns Hopkins University, Baltimore, MD, USA.
OBJECTIVES: To assess the cost-effectiveness of lecanemab for early Alzheimer’s disease by incorporating real option value (ROV), capturing the added value of delayed progression in enabling access to future therapies such as oral semaglutide.
METHODS: We developed a state-transition Markov model to assess the cost-effectiveness of lecanemab for early-stage Alzheimer’s disease (AD), with and without incorporating ROV. The model simulated a cohort of 1,000 U.S. adults aged ≥71 years with mild cognitive impairment (MCI) or mild AD dementia, based on the CLARITY-AD trial. Individuals transitioned through five health states—MCI, mild, moderate, severe AD, and death—over a lifetime horizon from a societal perspective. Sub-states captured treatment discontinuation due to adverse events such as amyloid-related imaging abnormalities (ARIA). Two strategies were compared: standard of care (SOC) and SOC plus lecanemab. A third scenario modeled access to semaglutide, assuming availability after 1, 3, or 5 years with 80% uptake. Model inputs were sourced from clinical trials, cohort studies, and public datasets. Outcomes included discounted QALYs, costs, ICERs, and INMBs, using a $150,000/QALY threshold. Deterministic and probabilistic sensitivity analyses assessed uncertainty in semaglutide timing, efficacy, and uptake. Analyses followed ISPOR-SMDM modeling guidelines.
RESULTS: Under traditional CEA, lecanemab increased QALYs (4,777 vs. 4,599) but at higher costs ($824M vs. $789M), yielding an ICER of $195,584/QALY and an INMB of -$8M. In the ROV-CEA, lecanemab was not cost-effective under any scenario. A 1-year wait produced fewer QALYs and higher costs (INMB: -$61M); a 3-year delay yielded the greatest loss (-$261M). Results were sensitive to lecanemab’s efficacy, cost, adverse event risk, and semaglutide uptake.
CONCLUSIONS: Incorporating ROV did not improve lecanemab’s cost-effectiveness. Modest delays in progression were offset by high cost, adverse events, and limited future therapy uptake. ROV should be considered in health technology assessments, but it does not rescue lecanemab’s value versus SOC under current assumptions.
METHODS: We developed a state-transition Markov model to assess the cost-effectiveness of lecanemab for early-stage Alzheimer’s disease (AD), with and without incorporating ROV. The model simulated a cohort of 1,000 U.S. adults aged ≥71 years with mild cognitive impairment (MCI) or mild AD dementia, based on the CLARITY-AD trial. Individuals transitioned through five health states—MCI, mild, moderate, severe AD, and death—over a lifetime horizon from a societal perspective. Sub-states captured treatment discontinuation due to adverse events such as amyloid-related imaging abnormalities (ARIA). Two strategies were compared: standard of care (SOC) and SOC plus lecanemab. A third scenario modeled access to semaglutide, assuming availability after 1, 3, or 5 years with 80% uptake. Model inputs were sourced from clinical trials, cohort studies, and public datasets. Outcomes included discounted QALYs, costs, ICERs, and INMBs, using a $150,000/QALY threshold. Deterministic and probabilistic sensitivity analyses assessed uncertainty in semaglutide timing, efficacy, and uptake. Analyses followed ISPOR-SMDM modeling guidelines.
RESULTS: Under traditional CEA, lecanemab increased QALYs (4,777 vs. 4,599) but at higher costs ($824M vs. $789M), yielding an ICER of $195,584/QALY and an INMB of -$8M. In the ROV-CEA, lecanemab was not cost-effective under any scenario. A 1-year wait produced fewer QALYs and higher costs (INMB: -$61M); a 3-year delay yielded the greatest loss (-$261M). Results were sensitive to lecanemab’s efficacy, cost, adverse event risk, and semaglutide uptake.
CONCLUSIONS: Incorporating ROV did not improve lecanemab’s cost-effectiveness. Modest delays in progression were offset by high cost, adverse events, and limited future therapy uptake. ROV should be considered in health technology assessments, but it does not rescue lecanemab’s value versus SOC under current assumptions.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE561
Topic
Economic Evaluation, Health Policy & Regulatory, Health Technology Assessment
Disease
Geriatrics, Neurological Disorders