OBJECTIVES: Emerging therapies for Alzheimer’s disease (AD) target the underlying disease biology in hopes of slowing cognitive and functional decline. Given the high expected cost of these therapies and the large potential treatable population, there is an urgent need to understand their economic impact, and compare their costs/benefits across patient subgroups.

METHODS: Analyses were conducted using the Future Elderly Model, which draws on nationally representative datasets such as the Health and Retirement Study, and has been extensively validated. From a US societal perspective, our microsimulation compared a hypothetical disease-modifying therapy (DMT) with standard of care over a lifetime horizon in simulants aged 51+ with mild cognitive impairment or mild AD. The treatment effect chosen consisted of a 20% reduction in cognitive decline and 40% reduction in functional decline (sensitivity analyses were conducted for smaller/larger effects). Simulants discontinued treatment when progressing to moderate AD. We stratified simulants by baseline age and cognition, and calculated lifetime cost-effective (CE) treatment prices based on a willingness-to-pay threshold of $150,000 per QALY (quality-adjusted life-year) gained.

RESULTS: Across all patients, the hypothetical DMT resulted in a gain of 0.21 QALYs, a reduction in total costs of $10,413, resulting in a lifetime CE treatment price of $41,933. In simulants younger than 65 with probable memory impairment at baseline, treatment resulted in a lifetime CE price of $52,672. In simulants aged 65 and older with dementia at baseline, treatment resulted in a lifetime CE price of $33,057.

CONCLUSIONS: Our study shows there is wide heterogeneity in the clinical and economic value of emerging AD DMTs when baseline age and cognition are taken into account. Such variation in outcomes has important policy implications, ranging from reimbursement to care delivery. Future research may consider alternative means of subgrouping.