OBJECTIVES: Prior studies have evaluated the value of aducanumab and lecanemab in Alzheimer's Disease (AD). Given that a third anti-amyloid antibody treatment, donanemab, is on its way for approval, a comprehensive analysis that evaluates the relative value of all three approved AD treatments is necessary. In this study, we aim to evaluate the cost-effectiveness of donanemab compared to the current approved therapies, aducanumab and lecanemab, for use in the treatment of AD.

METHODS: We developed a Markov cohort model that simulates the onset and prognosis of AD under the three treatment strategies in Excel. We used the estimate of each treatment’s efficacy of reducing AD progression from clinical trials. We estimated lifetime health (QALYs) and economic outcomes of three treatment regimens among 75 year-old patients with early AD. We took a healthcare perspective, and computed the ICER against a threshold of $150,000 per QALY. To assess the uncertainty in model parameters, we performed a sensitivity analysis.

RESULTS: We found that aducanumab had higher costs and lower QALYs than lecanemab and is therefore dominated. With the assumption that donanemab will be priced the same as lecanemab ($26,500/yr), both of these drugs are more expensive than standard of care (SoC), though they generate 0.08 and 0.10 more QALYs, respectively. Donanemab and lecanemab had an ICER of $185,822.92/QALY and $794,895.54/QALY; therefore, they are not cost-effective at the threshold. According to our sensitivity analysis, the biggest driver of the ICER for all three treatments was the drugs’ ability to keep an individual from transitioning from mild to moderate AD.

CONCLUSIONS: Lecanemab and aducanumab are not cost effective at an ICER of $150,000 per QALY. Donanemab does not yet have a set price, though based on our analysis, it would be cost effective at $16,200 per year.