Impact of Slowing Alzheimer’s Disease (AD) Progression: A Simulation Model in a Population of Patients with Early AD in the United States

Author(s)

Bloudek L1, Sullivan S1, Sheth S2, Elsea D1, Kang A1, Aly A3, Neumann P4
1Curta Inc., Seattle, WA, USA, 2Novo Nordisk, Livingston, NJ, USA, 3Novo Nordisk, Plainsboro, NJ, USA, 4Tufts Medical Center, Boston, MA, USA

OBJECTIVES: The primary treatment goal for Alzheimer’s disease (AD) is to slow or stop disease progression. This study estimated the value, from various perspectives, of slowed disease progression (SDP) compared with natural history (NH) in early AD.

METHODS: A Markov cohort model was developed to simulate the progression of patients through AD health states based on Clinical Dementia Rating Scale Sum of Boxes (CDR-SB) scores: mild cognitive impairment due to AD (MCI); mild, moderate and severe AD dementia. Perspectives included: Medicare, Medicaid, commercial, patient and care partner. The model assumed baseline MCI severity as CDR-SB score 2.0, and patient and care partner baseline ages of 70 years (60 years for commercial perspective, shifting to Medicare after age 65). For SDP, the base case assumed 20% rate of reduction in CDR-SB score decline measured at 24 months, with treatment benefit until moderate–severe AD dementia; thereafter, the rate reflected NH. Model outcomes, projected over a 10-year horizon (discounted at 3%), included years spent in AD dementia states, years in home community care; and healthcare (excluding AD treatment), non-healthcare, patient out-of-pocket (e.g., travel), long-term care and patient/care partner lost productivity costs.

RESULTS: Compared with NH, patients in SDP spent more time in earlier stages and less time in advanced stages of AD dementia (incremental years: MCI, 0.44; mild, 0.17; moderate, −0.27; severe, −0.14). Cost savings (incremental costs SDP vs NH) were mostly observed from the patient/care partner perspective (−$22,581); less for Medicaid (−$11,864) and commercial (−$1,385); Medicare, $3,711. From all perspectives, the model showed the greatest sensitivity to the assumption for reduction in AD progression.

CONCLUSIONS: This study showed that possible cost savings from slowing AD progression were greatest from the patient/care partner perspective. To assess the full value of new AD treatments, the broadest range of impacts to patients, care partners and payers should be considered.

Conference/Value in Health Info

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

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

Code

EE163

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas

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