OBJECTIVES: There is concern that standard cost-effectiveness analyses can obscure important differences in outcomes across demographic groups. In this paper, we evaluate the effect of novel anti-amyloid treatments for Alzheimer’s disease (AD) on health-economic outcomes among ethnoracial groups in the United States.

METHODS: We used a previously validated mathematical model of Alzheimer’s disease treatment to project health and economic outcomes under usual care vs. with donanemab (an exemplar anti-amyloid antibody) for three ethnoracial groups: Hispanic, non-Hispanic Black, and non-Hispanic White. Key model inputs included the efficacy of donanemab (32% reduction in disease progression); price of donanemab ($26,500/year); relative medical care costs for Hispanic, Black, and White individuals (1.10, 1.22, 1.00); and likelihood of timely diagnosis for individuals with AD in the three ethnoracial groups (44%, 37%, and 61%). Outcomes include healthcare sector costs (in 2020 USD), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) at a lifetime horizon.

RESULTS: We project that a universal rollout of donanemab to eligible patients would result in a gain of 1.71 QALYs/100,000 patients with AD and increase healthcare sector cost by $389,000, yielding an ICER of $228,000/QALY. Relative to their share of the population with AD, Hispanic individuals accrue 5% more QALY gains than expected, Black individuals 35% less, and White individuals 6% more. Sensitivity analysis with all groups assigned an equalized 61% likelihood of timely diagnosis alters the direction of these inequalities: Hispanic individuals accrue 24% more QALY gains than expected, Black individuals 5% more, and White individuals 5% less.

CONCLUSIONS: Based on current ethnoracial disparities in AD care, the benefits and costs of anti-amyloid treatment are likely to be unevenly distributed between ethnoracial groups, with Black individuals receiving a markedly lower share of the benefits. Efforts to improve timely diagnosis rates for Black patients would facilitate a more equitable distribution of benefits.