The Health Equity Impact of a Hypothetical Disease-Modifying Treatment for Alzheimer's Disease in the United States: A Distributional Cost-Effectiveness Analysis

Author(s)

Synnott P1, Lin PJ1, Ollendorf D2, Zhu Y1, Majda T3, Kowal S3
1Tufts Medical Center, Boston, MA, USA, 2Institute for Clinical and Economic Review, Boston, MA, USA, 3Genentech, Alameda, CA, USA

OBJECTIVES: The arrival of new medications for Alzheimer’s disease (AD) prompted efforts to measure value using cost-effectiveness analysis (CEA). However, conventional CEAs measure value for an “average” patient. As AD disproportionately affects historically marginalized populations, it is important to evaluate which population subgroups will be better- or worse-off from funding AD treatments, and to quantify overall health equity impacts.

METHODS: We conducted a US population-based distributional CEA of AD treatment among 25 subgroups defined by race/ethnicity (5 categories) and social vulnerability (5 quintiles). A CEA aligned to published models was updated to reflect disparities in AD diagnosis trends (timing, stage) and treatment access. We assumed a cost-effective hypothetical treatment that reduced cognitive decline by 45% and 35% for mild cognitive impairment (MCI) and mild dementia, respectively. We expressed opportunity costs in terms of lost quality-adjusted life-years (QALYs), and assumed each subgroup bore a share proportionate to their population size. We quantified changes in population health resulting from health gains and opportunity costs from treatment, and used the Atkinson Index to examine equity tradeoffs.

RESULTS: At an opportunity cost threshold of $150,000/QALY, treatment improved population health, adding 28,197 QALYs. The benefit was concentrated among subgroups in the middle of the health distribution (i.e., White subgroups across all social vulnerability quintiles and the 2 most socially-vulnerable Black subgroups). Treatment also improved health equity. In scenario analyses, in which we assumed all patients had access to treatment and started treatment during the MCI stage, population health improved more than tenfold in comparison to the base case. Conclusions were robust across a wide range of inequality aversion parameters.

CONCLUSIONS: Our analysis suggests AD treatment could improve population health and health equity. Health systems changes (e.g., expanding diagnostic testing and starting patients on treatment at earlier disease stages) are key to strengthening treatment and equity impacts.

Conference/Value in Health Info

2024-05, ISPOR 2024, Atlanta, GA, USA

Value in Health, Volume 27, Issue 6, S1 (June 2024)

Code

EE80

Topic

Economic Evaluation, Health Policy & Regulatory, Study Approaches

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision Modeling & Simulation, Health Disparities & Equity

Disease

Drugs, Geriatrics, Neurological Disorders

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