OBJECTIVES:

Given the emergence of new therapies for Alzheimer’s disease (AD), it is critical to understand the impact of access factors on health equity. Distributional cost-effectiveness analysis (DCEA) can quantify tradeoffs between overall health gains and underlying impacts on health equity. Our objective was to support development of a DCEA for AD by summarizing the existing literature across race, ethnicity, and social determinants of health (SDOH).

METHODS:

We searched biomedical literature databases, the Tufts CEA Registry, and grey literature for English-language studies that investigated the impact of race/ethnicity and SDOH on AD outcomes relevant to economic modeling, including incidence, demographics, disease progression, care setting, caregiver burden, and costs.

RESULTS:

Our search yielded 8,744 results and 27 relevant references. Two studies stratified data elements by SDOH and limited data were found for Asian and Native populations. We identified robust evidence for Black, non-Hispanic White, and Hispanic subgroups related to AD prevalence and patient characteristics at diagnosis. For example, several studies reported higher prevalence and delayed diagnoses among Black and Hispanic participants compared to non-Hispanic White participants. Subgroup-specific evidence for mortality, utilities, caregiver burden, out-of-pocket costs, and long-term care costs was limited and will require assumptions to be incorporated into DCEA. However, the DCEA can explore distributional trends in some of these inputs (e.g., out-of-pocket expenditures, which the all-cause dementia literature suggests are lower for Black and Hispanic subgroups).

CONCLUSIONS:

Literature on the distributional impacts on AD epidemiology is robust and can be modeled in DCEA. Further evidence and assumptions are needed to estimate impacts for some outcomes or across subgroups defined by SDOH. DCEA can help evaluate distributional impacts of emerging AD therapies and guide policies affecting access to these therapies, including Medicare’s coverage with evidence development policy for monoclonal antibodies and prescribing requirements to confirm amyloid positivity.