The health economics of an Alzheimer’s prevention therapy

Abstract

AbstractBackgroundAmyloid reducing antibodies have been shown or suggested to slow decline in early Alzheimer’s disease (AD), and prevention trials in preclinical AD are ongoing. We estimate cost‐effectiveness of AD prevention from a payer perspective, which considers cost offsets and QALYs gains, and a societal perspective, which adds reduction in caregiver burden.MethodWe estimate cost‐effectiveness in the 2023 cohort of 55–79‐year‐olds with a Markov model under the following assumptions: Everyone would undergo an AD blood test (cost $125), which would generate positive or negative results in 80% of cases with sensitivity and specificity of 80% and inconclusive results in 20%. Individuals (80%) testing positive would go directly to treatment, the other 20% to confirmatory testing with PET (50%, cost of $4,000) or CSF (50%, cost of $600), receiving treatment accordingly. Individuals testing negative at any stage would return for another blood test in five years and those with inconclusive results in one. We assume average annual therapy cost of $5,850 per person (the list price of the PCSK9 inhibitors) for duration of 12 years, treatment effect of 50%, and four (baseline and 6, 12 and 18 month) MRIs ($400) for ARIA.ResultThe program would be cost‐effective from a payer perspective with cost of $45,157 and value of $53,721 per person. From a societal perspective, it would generate $24,704 in net value per person (Figure 1). If the treatment delayed progression by 25 percent, the program would no longer be cost‐effective from a payer or societal perspective. The treatment would have to eliminate the progression from preclinical AD to MCI to become cost‐neutral (Figure 2). Higher specificity of the blood test would decrease cost per person with no change in value generation and higher sensitivity would increase cost and decrease valueConclusionA prevention treatment that reduces the progression from preclinical AD to MCI by 50% could be economically viable from a payer perspective. The results are preliminary and need to be adjusted as more data become available, but the findings should stimulate a discussion among stakeholders about the contours and economic viability of such a prevention program.