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Handels R, Herring WL, Grimm S, Sköldunger A, Winblad B, Wimo A, Jönsson L. New International Pharmaco-Economic Collaboration on Alzheimer's Disease (IPECAD) Open-Source Model Framework for the Health Technology Assessment of Early Alzheimer's Disease Treatment: Development and Use Cases. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02790-6. [PMID: 39094686 DOI: 10.1016/j.jval.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/02/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES Reimbursement decisions for new Alzheimer's disease (AD) treatments are informed by economic evaluations. An open-source model with intuitive structure for model cross-validation can support the transparency and credibility of such evaluations. We describe the new International Pharmaco-Economic Collaboration on Alzheimer's Disease (IPECAD) open-source model framework (version 2) for the health-economic evaluation of early AD treatment and use it for cross-validation and addressing uncertainty. METHODS A cohort state-transition model using a categorized composite domain (cognition and function) was developed by replicating an existing reference model and testing it for internal validity. Then, features of existing Institute for Clinical and Economic Review (ICER) and Alzheimer's Disease Archimedes Condition-Event Simulator (AD-ACE) models assessing lecanemab treatment were implemented for model cross-validation. Additional uncertainty scenarios were performed on choice of efficacy outcome from trial, natural disease progression, treatment effect waning and stopping rules, and other methodological choices. The model is available open-source as R code, spreadsheet, and web-based version via https://github.com/ronhandels/IPECAD. RESULTS In the IPECAD model incremental life-years, quality-adjusted life-years (QALY) gains and cost savings were 21% to 31% smaller compared with the ICER model and 36% to 56% smaller compared with the AD-ACE model. IPECAD model results were particularly sensitive to assumptions on treatment effect waning and stopping rules and choice of efficacy outcome from trial. CONCLUSIONS We demonstrated the ability of a new IPECAD open-source model framework for researchers and decision makers to cross-validate other (Health Technology Assessment submission) models and perform additional uncertainty analyses, setting an example for open science in AD decision modeling and supporting important reimbursement decisions.
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Affiliation(s)
- Ron Handels
- Alzheimer Center Limburg, Faculty of Health Medicine and Life Sciences, Mental Health and Neuroscience Research Institute, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands; Division of Neurogeriatrics, Department of Neurobiology Care Sciences and Society Karolinska Institutet BioClinicum J9:20, Solna, Sweden.
| | - William L Herring
- Division of Neurogeriatrics, Department of Neurobiology Care Sciences and Society Karolinska Institutet BioClinicum J9:20, Solna, Sweden; Health Economics, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Sabine Grimm
- Department of Clinical Epidemiology and Medical Technology Assessment, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anders Sköldunger
- Division of Neurogeriatrics, Department of Neurobiology Care Sciences and Society Karolinska Institutet BioClinicum J9:20, Solna, Sweden
| | - Bengt Winblad
- Division of Neurogeriatrics, Department of Neurobiology Care Sciences and Society Karolinska Institutet BioClinicum J9:20, Solna, Sweden; Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Anders Wimo
- Division of Neurogeriatrics, Department of Neurobiology Care Sciences and Society Karolinska Institutet BioClinicum J9:20, Solna, Sweden
| | - Linus Jönsson
- Division of Neurogeriatrics, Department of Neurobiology Care Sciences and Society Karolinska Institutet BioClinicum J9:20, Solna, Sweden
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Darab MG, Engel L, Henzler D, Lauerer M, Nagel E, Brown V, Mihalopoulos C. Model-Based Economic Evaluations of Interventions for Dementia: An Updated Systematic Review and Quality Assessment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:503-525. [PMID: 38554246 PMCID: PMC11178626 DOI: 10.1007/s40258-024-00878-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND There has been an increase in model-based economic evaluations of interventions for dementia. The most recent systematic review of economic evaluations for dementia highlighted weaknesses in studies, including lack of justification for model assumptions and data inputs. OBJECTIVE This study aimed to update the last published systematic review of model-based economic evaluations of interventions for dementia, including Alzheimer's disease, with a focus on any methodological improvements and quality assessment of the studies. METHODS Systematic searches in eight databases, including PubMed, Cochrane, Embase, CINAHL, PsycINFO, EconLit, international HTA database, and the Tufts Cost-Effectiveness Analysis Registry were undertaken from February 2018 until August 2022. The quality of the included studies was assessed using the Philips checklist and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. The findings were summarized through narrative analysis. RESULTS This review included 23 studies, comprising cost-utility analyses (87%), cost-benefit analyses (9%) and cost-effectiveness analyses (4%). The studies covered various interventions, including pharmacological (n = 10, 43%), non-pharmacological (n = 4, 17%), prevention (n = 4, 17%), diagnostic (n = 4, 17%) and integrated (n = 1, 4%) [diagnostics-pharmacologic] strategies. Markov transition models were commonly employed (65%), followed by decision trees (13%) and discrete-event simulation (9%). Several interventions from all categories were reported as being cost effective. The quality of reporting was suboptimal for the Methods and Results sections in almost all studies, although the majority of studies adequately addressed the decision problem, scope, and model-type selection in their economic evaluations. Regarding the quality of methodology, only a minority of studies addressed competing theories or clearly explained the rationale for model structure. Furthermore, few studies systematically identified key parameters or assessed data quality, and uncertainty was mostly addressed partially. CONCLUSIONS This review informs future research and resource allocation by providing insights into model-based economic evaluations for dementia interventions and highlighting areas for improvement.
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Affiliation(s)
- Mohsen Ghaffari Darab
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.
- Institute for Management in Medicine and Health Sciences, University of Bayreuth, Bayreuth, Germany.
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dennis Henzler
- Institute for Management in Medicine and Health Sciences, University of Bayreuth, Bayreuth, Germany
| | - Michael Lauerer
- Institute for Management in Medicine and Health Sciences, University of Bayreuth, Bayreuth, Germany
| | - Eckhard Nagel
- Institute for Management in Medicine and Health Sciences, University of Bayreuth, Bayreuth, Germany
| | - Vicki Brown
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Peng Y, Chen Q, Xue YH, Jin H, Liu S, Du MQ, Yao SY. Ginkgo biloba and Its Chemical Components in the Management of Alzheimer's Disease. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2024; 52:625-666. [PMID: 38654507 DOI: 10.1142/s0192415x24500277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The pathogenesis of Alzheimer's disease (AD), a degenerative disease of the central nervous system, remains unclear. The main manifestations of AD include cognitive and behavioral disorders, neuropsychiatric symptoms, neuroinflammation, amyloid plaques, and neurofibrillary tangles. However, current drugs for AD once the dementia stage has been reached only treat symptoms and do not delay progression, and the research and development of targeted drugs for AD have reached a bottleneck. Thus, other treatment options are needed. Bioactive ingredients derived from plants are promising therapeutic agents. Specifically, Ginkgo biloba (Gb) extracts exert anti-oxidant, anticancer, neuroplastic, neurotransmitter-modulating, blood fluidity, and anti-inflammatory effects, offering alternative options in the treatment of cardiovascular, metabolic, and neurodegenerative diseases. The main chemical components of Gb include flavonoids, terpene lactones, proanthocyanidins, organic acids, polysaccharides, and amino acids. Gb and its extracts have shown remarkable therapeutic effects on various neurodegenerative diseases, including AD, with few adverse reactions. Thus, high-quality Gb extracts are a well-established treatment option for AD. In this review, we summarize the insights derived from traditional Chinese medicine, experimental models, and emerging clinical trials on the role of Gb and its chemical components in the treatment of the main clinical manifestations of AD.
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Affiliation(s)
- Yong Peng
- Department of Neurology, Affiliated First Hospital of Hunan Traditional, Chinese Medical College, Zhuzhou, Hunan, P. R. China
- Department of Neurology, Affiliated Provincial Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, P. R. China
| | - Quan Chen
- Department of Neurology, Affiliated First Hospital of Hunan Traditional, Chinese Medical College, Zhuzhou, Hunan, P. R. China
- Department of Neurology, Affiliated Provincial Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, P. R. China
| | - Ya-Hui Xue
- Department of Neurology, Affiliated First Hospital of Hunan Traditional, Chinese Medical College, Zhuzhou, Hunan, P. R. China
- Department of Neurology, Affiliated Provincial Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, P. R. China
| | - Hong Jin
- Department of Neurology, Affiliated First Hospital of Hunan Traditional, Chinese Medical College, Zhuzhou, Hunan, P. R. China
- Department of Neurology, Affiliated Provincial Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, P. R. China
| | - Shu Liu
- Department of Neurology, Affiliated First Hospital of Hunan Traditional, Chinese Medical College, Zhuzhou, Hunan, P. R. China
- Department of Neurology, Affiliated Provincial Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, P. R. China
| | - Miao-Qiao Du
- Department of Neurology, Affiliated First Hospital of Hunan Traditional, Chinese Medical College, Zhuzhou, Hunan, P. R. China
- Department of Neurology, Affiliated Provincial Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, P. R. China
| | - Shun-Yu Yao
- Department of Neurology, Affiliated First Hospital of Hunan Traditional, Chinese Medical College, Zhuzhou, Hunan, P. R. China
- Department of Neurology, Affiliated Provincial Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, P. R. China
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Nguyen HV, Mital S, Knopman DS, Alexander GC. Cost-Effectiveness of Lecanemab for Individuals With Early-Stage Alzheimer Disease. Neurology 2024; 102:e209218. [PMID: 38484190 DOI: 10.1212/wnl.0000000000209218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/20/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Little is known regarding the cost-effectiveness of lecanemab (Leqembi), a monoclonal antibody approved by the US Food and Drug Administration in January 2023 for the treatment of mild cognitive impairment (MCI) or mild dementia due to Alzheimer disease (AD). This study aims to quantify the cost-effectiveness of lecanemab and how it varies based on the accuracy of AD testing and individuals' APOE ε4 status. METHODS Seven alternative test-treat-target strategies defined by combinations of testing approaches (PET, CSF, or plasma assay), treatment choices (standard of care [SoC] alone or lecanemab in addition to SoC), and targeting strategies (targeting APOE ε4 noncarriers or heterozygous patients or not) were compared. A hybrid decision tree-Markov cohort model was constructed with 5 states: (1) MCI (Clinical Dementia Rating-Sum of Boxes [CDR-SB] 0-4.5); (2) mild dementia (CDR-SB 4.6-9.5); (3) moderate dementia (CDR-SB 9.6-16); (4) severe dementia (CDR-SB >16); and (5) death. Effectiveness was measured by quality-adjusted life years and costs from third-party and societal perspectives were estimated in 2022 US dollars over a lifetime horizon. RESULTS Among the 7 test-treat-target strategies, SoC alone was the optimal strategy from a cost-effectiveness perspective. Neither targeted lecanemab treatment nor treatment unrestricted by APOE ε4 genotype was cost-effective vs SoC alone, regardless of the test used to diagnose patients with early-stage AD. However, CSF assay followed by targeted treatment would become cost-effective if lecanemab is priced below $5,100 per year. These results were robust to the accuracy of diagnostic testing and rates of lecanemab discontinuation and adverse events. DISCUSSION Neither targeted lecanemab treatment nor treatment unrestricted by APOE ε4 genotype is cost-effective vs SoC alone for patients with MCI or mild dementia due to AD. Lecanemab would be cost-effective in some settings if priced below $5,100 per year.
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Affiliation(s)
- Hai V Nguyen
- From the School of Pharmacy (H.V.N.), Memorial University of Newfoundland, St. John's, Newfoundland & Labrador; College of Pharmacy (S.M.), University of Manitoba, Winnipeg, Canada; Department of Neurology (D.S.K.), Mayo Clinic College of Medicine, Rochester, MN; Center for Drug Safety and Effectiveness (G.C.A.), and Department of Epidemiology (G.C.A.), Johns Hopkins Bloomberg School of Public Health; and Division of General Internal Medicine (G.C.A.), Johns Hopkins Medicine, Baltimore, MD
| | - Shweta Mital
- From the School of Pharmacy (H.V.N.), Memorial University of Newfoundland, St. John's, Newfoundland & Labrador; College of Pharmacy (S.M.), University of Manitoba, Winnipeg, Canada; Department of Neurology (D.S.K.), Mayo Clinic College of Medicine, Rochester, MN; Center for Drug Safety and Effectiveness (G.C.A.), and Department of Epidemiology (G.C.A.), Johns Hopkins Bloomberg School of Public Health; and Division of General Internal Medicine (G.C.A.), Johns Hopkins Medicine, Baltimore, MD
| | - David S Knopman
- From the School of Pharmacy (H.V.N.), Memorial University of Newfoundland, St. John's, Newfoundland & Labrador; College of Pharmacy (S.M.), University of Manitoba, Winnipeg, Canada; Department of Neurology (D.S.K.), Mayo Clinic College of Medicine, Rochester, MN; Center for Drug Safety and Effectiveness (G.C.A.), and Department of Epidemiology (G.C.A.), Johns Hopkins Bloomberg School of Public Health; and Division of General Internal Medicine (G.C.A.), Johns Hopkins Medicine, Baltimore, MD
| | - G Caleb Alexander
- From the School of Pharmacy (H.V.N.), Memorial University of Newfoundland, St. John's, Newfoundland & Labrador; College of Pharmacy (S.M.), University of Manitoba, Winnipeg, Canada; Department of Neurology (D.S.K.), Mayo Clinic College of Medicine, Rochester, MN; Center for Drug Safety and Effectiveness (G.C.A.), and Department of Epidemiology (G.C.A.), Johns Hopkins Bloomberg School of Public Health; and Division of General Internal Medicine (G.C.A.), Johns Hopkins Medicine, Baltimore, MD
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Scott IA. Monoclonal antibodies for treating early Alzheimer disease-a commentary on recent 'positive' trials. Age Ageing 2024; 53:afae023. [PMID: 38411409 DOI: 10.1093/ageing/afae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 12/30/2023] [Indexed: 02/28/2024] Open
Abstract
Recent phase 3 randomised controlled trials of amyloid-targeting monoclonal antibodies in people with pre-clinical or early Alzheimer disease have reported positive results, raising hope of finally having disease-modifying drugs. Given their far-reaching implications for clinical practice, the methods and findings of these trials, and the disease causation theory underpinning the mechanism of drug action, need to be critically appraised. Key considerations are the representativeness of trial populations; balance of prognostic factors at baseline; psychometric properties and minimal clinically important differences of the primary efficacy outcome measures; level of study fidelity; consistency of subgroup analyses; replication of findings in similar trials; sponsor role and potential conflicts of interest; consistency of results with disease causation theory; cost and resource estimates; and alternative prevention and treatment strategies. In this commentary, we show shortcomings in each of these areas and conclude that monoclonal antibody treatment for early Alzheimer disease is lacking high-quality evidence of clinically meaningful impacts at an affordable cost.
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Affiliation(s)
- Ian A Scott
- Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Morin P, Aguilar BJ, Li X, Chen J, Berlowitz D, Zhang R, Tahami Monfared AA, Zhang Q, Xia W. Alzheimer's Disease Stage Transitions Among United States Veterans. J Alzheimers Dis 2024; 97:687-695. [PMID: 38143359 DOI: 10.3233/jad-230850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) and related dementias are progressive neurological disorders with stage-specific clinical features and challenges. An important knowledge gap is the "window of time" within which patients transition from mild cognitive impairment or mild AD to moderate or severe AD. Better characterization/establishment of transition times would help clinicians initiating treatments, including anti-amyloid therapy. OBJECTIVE To describe cognitive test score-based AD stage transitions in Veterans with AD in the US Veterans Affairs Healthcare System (VAHS). METHODS This retrospective analysis (2010-2019) identified Veterans with AD from the VAHS Electronic Health Record (EHR) notes. AD stage was based on Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), or Saint Louis University Mental Status (SLUMS) Examination scores in the EHR. RESULTS We identified 296,519 Veterans with cognitive test-based AD staging. Over the 10-year study, the proportion of veterans with MMSE scores declined from 24.9% to 9.5% while those with SLUMS rose from 9.0% to 17.8%; and MoCA rose from 5.0% to 25.4%. The average forward transition times between each stage were approximately 2-4 years, whether assessed by MMSE, MoCA, or SLUMS. CONCLUSION The average transition time for cognitive test-based assessments of initial cognitive decline, early-stage AD, and moderate/severe AD in the VAHS is 2-4 years. In view of the short window for introducing disease-modifying therapy and the significant benefits of early treatment of AD, our data suggest a critical need for treatment guidelines in the management of AD.
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Affiliation(s)
- Peter Morin
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Byron J Aguilar
- Geriatric Research Education and Clinical Center, Bedford VA Healthcare System, Bedford, MA, USA
| | - Xuyang Li
- Geriatric Research Education and Clinical Center, Bedford VA Healthcare System, Bedford, MA, USA
| | - Jinying Chen
- Department of Preventive Medicine and Epidemiology, Data Science Core, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Dan Berlowitz
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Raymond Zhang
- Alzheimer's Disease and Brain Health, EisaiInc., Nutley, NJ, USA
| | - Amir Abbas Tahami Monfared
- Alzheimer's Disease and Brain Health, EisaiInc., Nutley, NJ, USA
- Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Quanwu Zhang
- Alzheimer's Disease and Brain Health, EisaiInc., Nutley, NJ, USA
| | - Weiming Xia
- Geriatric Research Education and Clinical Center, Bedford VA Healthcare System, Bedford, MA, USA
- Department of Pharmacology, Physiology and Biophysics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Biological Sciences, Kennedy College of Science, University of Massachusetts Lowell, Lowell, MA, USA
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Park J, Simpson C, Patel K. Lecanemab: A Humanized Monoclonal Antibody for the Treatment of Early Alzheimer Disease. Ann Pharmacother 2023:10600280231218253. [PMID: 38095619 DOI: 10.1177/10600280231218253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE To review current pharmacology, pharmacokinetics/pharmacodynamics, safety, and efficacy of lecanemab in patients with Alzheimer disease. DATA SOURCES A literature search of PubMed (April 1, 2016-November 15, 2023) and ClinicalTrials.gov search were conducted using the following search terms: lecanemab and BAN2401. Additional articles were identified by hand from references. STUDY SELECTION AND DATA EXTRACTION We included English-language clinical trials, randomized controlled trials, reviews, and systematic reviews evaluating lecanemab pharmacology, efficacy, or safety in humans for the management of Alzheimer disease. DATA SYNTHESIS In the Clarity AD phase III trial, lecanemab led to a decrease in brain amyloid levels and showed moderate improvement in clinical measures of cognition and function. At 18 months, lecanemab 10 mg/kg biweekly exhibited a lower least squares mean change from baseline (1.21) compared to placebo (1.66) of Clinical Dementia Rating-Sum of Boxes score, signifying a significant difference of -0.45 (95% CI, -0.67 to -0.23; P < 0.001). In a subset of 698 participants, lecanemab reduced brain amyloid burden by -59.1 Centiloids (95% CI, -62.6 to -55.6). Lecanemab demonstrated favorable differences in Alzheimer Disease Assessment Scale-cognitive subscale 14, Alzheimer Disease Composite Score, and Alzheimer Disease Cooperative Study-Mild Cognitive Impairment-Activities of Daily Living scores. Adverse events included infusion-related reactions (26.4%) and amyloid-related imaging abnormalities (12.6%). RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Lecanemab reduces cognitive decline but raises concerns about intravenous administration, cost, and magnetic resonance imaging needs. Ongoing trials exploring subcutaneous dosing and positron emission tomography scans may offer solutions. CONCLUSION Lecanemab is a humanized monoclonal antibody that is selective for soluble amyloid-beta (Aβ) aggregates. Lecanemab has exhibited a decrease in brain Aβ plaques and moderately less decline on clinical measures of cognitive function.
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Yemm H, Peel E, Brooker D. "I guess you can interpret it in a number of ways like kind of a milder or the mildest form of dementia?": Multi-stakeholder perceptions of cognitive impairment. DEMENTIA 2023; 22:1799-1818. [PMID: 37696113 DOI: 10.1177/14713012231201596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Mild cognitive impairment (MCI) has a high prevalence and is a risk factor for dementia. Furthering understanding of MCI has been identified as a public health priority. This research aimed to explore views about the causes of cognitive impairment and identify associations between cognitive impairment, dementia, and normative ageing. METHOD Semi-structured qualitative interviews were conducted with 22 participants with different stakeholder perspectives on the area of MCI in England, and analysed thematically. RESULTS Our analysis focuses on two main themes: 1) causes of cognitive impairment, and 2) ageing, dementia, and dying. Most participants viewed cognitive impairment as a transitional state between normative ageing and dementia. Participants expressed their fear of cognitive impairment and dementia, and made clear links between cognitive impairment and dying. Participants also showed an awareness of the links between lifestyle factors and cognitive health. However, linkage between lifestyle and cognition was discussed only when explicitly asked, suggesting that this was not especially salient for participants when considering the causes and risk factors for cognitive impairment. CONCLUSION The results of this study highlight key areas for future public health initiatives, such as a focus on the multitude of benefits offered by adopting a healthy diet and physical exercise in reducing risk of cognitive impairment.
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Affiliation(s)
- H Yemm
- Helen McArdle Nursing and Care Research Institute, University of Sunderland, UK; Association for Dementia Studies, University of Worcester, UK
| | - E Peel
- Centre for Research in Communication and Culture, School of Social Sciences and Humanities, Loughborough University, UK
| | - D Brooker
- Association for Dementia Studies, University of Worcester, UK
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Burke JF, Kerber KA, Langa KM, Albin RL, Kotagal V. Lecanemab: Looking Before We Leap. Neurology 2023; 101:661-665. [PMID: 37479527 PMCID: PMC10585683 DOI: 10.1212/wnl.0000000000207505] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/26/2023] [Indexed: 07/23/2023] Open
Abstract
Lecanemab, a novel amyloid-sequestering agent, recently received accelerated Food and Drug Administration approval for the treatment of mild dementia due to Alzheimer disease (AD) and mild cognitive impairment (MCI). Approval was based on a large phase 3 trial, Clarity, which demonstrated reductions in amyloid plaque burden and cognitive decline with lecanemab. Three major concerns should give us pause before adopting this medication: Its beneficial effects are small, its harms are substantial, and its potential costs are unprecedented. Although lecanemab has a clear and statistically significant effect on cognition, its effect size is small and may not be clinically significant. The magnitude of lecanemab's cognitive effect is smaller than independent estimates of the minimally important clinical difference, implying that the effect may be imperceptible to a majority of patients and caregivers. Lecanemab's cognitive effects were numerically smaller than the effect of cholinesterase inhibitors and may be much smaller. The main argument in lecanemab's favor is that it may lead to greater cognitive benefit over time. Although plausible, there is a lack of evidence to support this conclusion. Lecanemab's harms are substantial. In Clarity, it caused symptomatic brain edema in 11% and symptomatic intracranial bleeding in 0.5% of participants. These estimates likely significantly underestimate these risks in general practice for 3 reasons: (1) Lecanemab likely interacts with other medications that increase bleeding, an effect minimized in Clarity. (2) The Clarity population is much younger than the real-world population with mild AD dementia and MCI (age 71 years vs 85 years) and bleeding risk increases with age. (3) Bleeding rates in trials are typically much lower than in clinical practice. Lecanemab's costs are unprecedented. Its proposed price of $26,500 is based on cost-effectiveness analyses with tenuous assumptions. However, even if cost-effective, it is likely to result in higher expenditures than any other medication. If its entire target population were treated, the aggregate medication expenditures would be $120 billion US dollars per year-more than is currently spent on all medications in Medicare Part D. Before adopting lecanemab, we need to know that lecanemab is not less effective, vastly more harmful, and 100× more costly than donepezil.
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Affiliation(s)
- James F Burke
- From the Division of Health Services Research (J.F.B., K.A.K.), Department of Neurology, Ohio State University, Columbus; and Department of Internal Medicine (K.M.L.), and Department of Neurology (R.L.A., V.K.), University of Michigan, Ann Arbor.
| | - Kevin A Kerber
- From the Division of Health Services Research (J.F.B., K.A.K.), Department of Neurology, Ohio State University, Columbus; and Department of Internal Medicine (K.M.L.), and Department of Neurology (R.L.A., V.K.), University of Michigan, Ann Arbor
| | - Kenneth M Langa
- From the Division of Health Services Research (J.F.B., K.A.K.), Department of Neurology, Ohio State University, Columbus; and Department of Internal Medicine (K.M.L.), and Department of Neurology (R.L.A., V.K.), University of Michigan, Ann Arbor
| | - Roger L Albin
- From the Division of Health Services Research (J.F.B., K.A.K.), Department of Neurology, Ohio State University, Columbus; and Department of Internal Medicine (K.M.L.), and Department of Neurology (R.L.A., V.K.), University of Michigan, Ann Arbor
| | - Vikas Kotagal
- From the Division of Health Services Research (J.F.B., K.A.K.), Department of Neurology, Ohio State University, Columbus; and Department of Internal Medicine (K.M.L.), and Department of Neurology (R.L.A., V.K.), University of Michigan, Ann Arbor
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Brück CC, Wolters FJ, Ikram MA, de Kok IMCM. Projections of costs and quality adjusted life years lost due to dementia from 2020 to 2050: A population-based microsimulation study. Alzheimers Dement 2023; 19:4532-4541. [PMID: 36916447 DOI: 10.1002/alz.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Efficient healthcare planning requires reliable projections of the future increase in costs and quality-adjusted life years (QALYs) lost due to dementia. METHODS We used the microsimulation model MISCAN-Dementia to simulate life histories and dementia occurrence using population-based Rotterdam Study data and nationwide birth cohort demographics. We estimated costs and QALYs lost in the Netherlands from 2020 to 2050, incorporating literature estimates of cost and utility for patients and caregivers by dementia severity and care setting. RESULTS Societal costs and QALYs lost due to dementia are estimated to double between 2020 and 2050. Costs are incurred predominantly through institutional (34%), formal home (31%), and informal home care (20%). Lost QALYs are mostly due to shortened life expectancy (67%) and, to a lesser extent, quality of life with severe dementia (14%). DISCUSSION To limit healthcare costs and quality of life losses due to dementia, interventions are needed that slow symptom progression and reduce care dependency.
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Affiliation(s)
- Chiara C Brück
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine and Alzheimer Center, Erasmus MC, Rotterdam, The Netherlands
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Yigit V, Kalender S, Cetinturk I. Is Aducanumab treatment developed to prevent progression of Alzheimer's disease cost-effective in Turkey? COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:51. [PMID: 37559042 PMCID: PMC10410945 DOI: 10.1186/s12962-023-00463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Alzheimer's Disease (AD), the most common type of dementia, is a chronic, progressive, and neurodegenerative brain discomfort that causes the be damage to brain cells. Although there is no definitive treatment for AD, various drug treatments are used to reduce and control the symptoms of the disease. Developed for the treatment of mild-stage Alzheimer's patients, Aducanumab is the only drug approved by the Food and Drug Administration (FDA) in the past two decades. However, the cost is very high and, in many countries, Aducanumab has not been approved due to insufficient clinical efficacy and lack of evidence yet. This study aims to analyze the cost-effectiveness of Aducanumab, which was developed for the treatment of mild-stage AD, from the patient's perspective. METHODS In the study, the Markov model was developed to determine the cost-effectiveness of Aducanumab compared to Standard of Care (SoC) therapy over a 5-year horizon. Cost and effectiveness data were taken from the literature. In the study, the discount rate was determined as 6%. The results were presented as the incremental cost-effectiveness ratio (ICER), which represents the cost per quality-adjusted life years (QALY). The results were retested with a one-way and probabilistic sensitivity analysis (PSA) due to possible uncertainties in the research parameters. The results were presented with the tornado diagram and the scatter plots. RESULTS With the Markov model, the total costs of Aducanumab and SoC treatments over a 5-year horizon were found to be 98.068 $ and 21.292 $, respectively. Aducanumab treatment had an incremental gain of 0.64 QALY and an incremental cost of 76.776 $ compared to the SoC treatment. The ICER value, which shows the additional cost per QALY of Aducanumab, was 119.408 $/QALY. As a result of the study, it was determined that Aducanumab was not cost-effective when compared to SoC treatment. Sensitivity analysis results showed stability against uncertainties. Aducanumab was confirmed not to be cost-effective with its current price and potential clinical benefit. CONCLUSION The result of the research is considered important in terms of providing evidence-based information on the cost-effectiveness of Aducanumab in Turkey. However, further, research is needed to evaluate Aducanumab's clinical efficacy and cost-effectiveness.
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Affiliation(s)
- Vahit Yigit
- Faculty of Economics and Administrative Sciences, Health Management Department, Suleyman Demirel University, 32200, Isparta, Turkey
| | - Selin Kalender
- Faculty of Economics and Administrative Sciences, Health Management Department, Suleyman Demirel University, 32200, Isparta, Turkey.
| | - Iskender Cetinturk
- Health Social Sciences Institute, Health Economics Doctorate Program, Suleyman Demirel University, 32200, Isparta, Turkey
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Igarashi A, Azuma MK, Zhang Q, Ye W, Sardesai A, Folse H, Chavan A, Tomita K, Tahami Monfared AA. Predicting the Societal Value of Lecanemab in Early Alzheimer's Disease in Japan: A Patient-Level Simulation. Neurol Ther 2023; 12:1133-1157. [PMID: 37188886 PMCID: PMC10310671 DOI: 10.1007/s40120-023-00492-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Alzheimer's disease (AD), a neurodegenerative disorder that progresses from mild cognitive impairment (MCI) to dementia, is responsible for significant burden on caregivers and healthcare systems. In this study, data from the large phase III CLARITY AD trial were used to estimate the societal value of lecanemab plus standard of care (SoC) versus SoC alone against a range of willingness-to-pay (WTP) thresholds from a healthcare and societal perspective in Japan. METHODS A disease simulation model was used to evaluate the impact of lecanemab on disease progression in early AD based on data from the phase III CLARITY AD trial and published literature. The model used a series of predictive risk equations based on clinical and biomarker data from the Alzheimer's Disease Neuroimaging Initiative and Assessment of Health Economics in Alzheimer's Disease II study. The model predicted key patient outcomes, including life years (LYs), quality-adjusted life years (QALYs), and total healthcare and informal costs of patients and caregivers. RESULTS Over a lifetime horizon, patients treated with lecanemab plus SoC gained an additional 0.73 LYs compared with SoC alone (8.50 years vs. 7.77 years). Lecanemab, with an average treatment duration of 3.68 years, was found to be associated with a 0.91 increase in patient QALYs and a total increase of 0.96 when accounting for caregiver utility. The estimated value of lecanemab varied according to the WTP thresholds (JPY 5-15 million per QALY gained) and the perspective employed. From the narrow healthcare payer's perspective, it ranged from JPY 1,331,305 to JPY 3,939,399. From the broader healthcare payer's perspective, it ranged from JPY 1,636,827 to JPY 4,249,702, while from the societal perspective, it ranged from JPY 1,938,740 to JPY 4,675,818. CONCLUSION The use of lecanemab plus SoC would improve health and humanistic outcomes with reduced economic burden for patients and caregivers with early AD in Japan.
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Affiliation(s)
- Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
- Department of Public Health, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Mie Kasai Azuma
- Medical Headquarter, Clinical Planning and Development, Eisai Co., Ltd., Tokyo, Japan
| | - Quanwu Zhang
- Global Alzheimer's Disease and Brain Health, Eisai Inc., 200 Metro Blvd., Nutley, NJ, 07110, USA
| | - Weicheng Ye
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | - Aditya Sardesai
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | - Henri Folse
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | - Ameya Chavan
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | | | - Amir Abbas Tahami Monfared
- Global Alzheimer's Disease and Brain Health, Eisai Inc., 200 Metro Blvd., Nutley, NJ, 07110, USA.
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
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Cummings J. Anti-Amyloid Monoclonal Antibodies are Transformative Treatments that Redefine Alzheimer's Disease Therapeutics. Drugs 2023; 83:569-576. [PMID: 37060386 PMCID: PMC10195708 DOI: 10.1007/s40265-023-01858-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 04/16/2023]
Abstract
Two anti-amyloid monoclonal antibodies (MABs)-lecanemab (Leqembi®) and aducanumab (Aduhelm®)-have been approved in the USA for the treatment of Alzheimer's disease (AD). Anti-amyloid monoclonal antibodies are the first disease-modifying therapies for AD that achieve slowing of clinical decline by intervening in the basic biological processes of the disease. These are breakthrough agents that can slow the inevitable progression of AD into more severe cognitive impairment. The results of trials of anti-amyloid MABs support the amyloid hypothesis and amyloid as a target for AD drug development. The success of MABs reflects a relentless application of neuroscience knowledge to solving major challenges facing humankind. The success of these transformative agents will foster the development of more anti-amyloid MABs, other types of anti-amyloid therapies, treatments of other targets of AD biology, and new approaches to therapies for an array of neurodegenerative disorders. Monoclonal antibodies have side effects and, during the period of treatment initiation, patients must be closely monitored for the occurrence of amyloid-related imaging abnormalities (ARIA) and infusion reactions. A successful first step in the development of disease-modifying therapy for AD defines desirable features for the next phase of therapeutic development including less frequent ARIA, more convenient administration, and greater efficacy. Unprecedented agents make new demands on patients and care partners, clinicians, payers, and health care systems. Collaboration among stakeholders is essential to take advantage of the therapeutic benefits offered by these agents and to make them widely available. Monoclonal antibodies usher in a new era in AD therapy and define a new landscape of what is possible for therapeutic development for neurodegenerative disorders.
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Affiliation(s)
- Jeffrey Cummings
- Joy Chambers-Grundy Professor of Brain Science, Chambers-Grundy Center for Transformative Neuroscience, Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), Las Vegas, NV, USA.
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Tahami Monfared AA, Ye W, Sardesai A, Folse H, Chavan A, Aruffo E, Zhang Q. A Path to Improved Alzheimer's Care: Simulating Long-Term Health Outcomes of Lecanemab in Early Alzheimer's Disease from the CLARITY AD Trial. Neurol Ther 2023; 12:863-881. [PMID: 37009976 DOI: 10.1007/s40120-023-00473-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION Alzheimer's disease (AD), a progressive neurodegenerative disease, is the main cause of dementia and one of the leading causes of death for elderly people in the USA. Lecanemab is a humanized IgG1 monoclonal antibody targeting amyloid protofibrils for the treatment of early AD [i.e., mild cognitive impairment (MCI) or mild AD dementia]. In a recent 18-month phase III trial, using a double-blind, placebo-controlled design, lecanemab treatment led to reduced brain amyloid burden and significant improvements in cognitive and functional abilities in individuals with early AD. METHODS An evidence-based patient-level disease simulation model was updated to estimate the long-term health outcomes of lecanemab plus standard of care (SoC) compared to SoC alone in patients with early AD and evidence of brain amyloid burden, using recent phase III trial data and published literature. The disease progression is described by changes in the underlying biomarkers of AD, including measures of amyloid and tau, and their connection to the clinical presentation of the disease assessed through various patient-level scales of cognition and function. RESULTS Lecanemab treatment was estimated to slow the progression of AD to moderate and severe stages and reduce the time spent in these more advanced states. In individuals with early AD, lecanemab plus SoC was associated with a gain of 0.71 quality-adjusted life-years (QALYs), a 2.95-year delay in mean time to progression to AD dementia, a reduction of 0.11 years in institutional care, and an additional 1.07 years in community care as shown in the base-case study. Improved health outcomes were demonstrated with lecanemab treatment when initiated earlier based on age, disease severity, or tau pathology, resulting in estimated gains in QALYs ranging from 0.77 to 1.09 years, compared to 0.4 years in the mild AD dementia subset, as shown by the model. CONCLUSION The study findings demonstrate the potential clinical value of lecanemab for individuals with early AD by slowing down disease progression and prolonging time in earlier stages of disease, which significantly benefits not only patients and caregivers but also society overall. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT03887455.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Eisai Inc., 200 Metro Blvd., Nutley, NJ, 07110, USA.
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
| | - Weicheng Ye
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | - Aditya Sardesai
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | - Henri Folse
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | - Ameya Chavan
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | - Elena Aruffo
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | - Quanwu Zhang
- Eisai Inc., 200 Metro Blvd., Nutley, NJ, 07110, USA
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Brodtmann A, Darby D, Oboudiyat C, Mahoney CJ, Le Heron C, Panegyres PK, Brew B. Assessing preparedness for Alzheimer disease-modifying therapies in Australasian health care systems. Med J Aust 2023; 218:247-249. [PMID: 36934371 DOI: 10.5694/mja2.51880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 03/20/2023]
Affiliation(s)
- Amy Brodtmann
- Monash University, Melbourne, VIC.,Florey Institute of Neuroscience and Mental Health, Melbourne, VIC
| | | | | | | | | | | | - Bruce Brew
- University of New South Wales, Sydney, NSW
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Tahami Monfared AA, Ye W, Sardesai A, Folse H, Chavan A, Kang K, Zhang Q. Estimated Societal Value of Lecanemab in Patients with Early Alzheimer's Disease Using Simulation Modeling. Neurol Ther 2023; 12:795-814. [PMID: 36929345 DOI: 10.1007/s40120-023-00460-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Alzheimer's disease (AD) is a progressive neurodegenerative disorder associated with memory, cognitive, and behavioral deficits, and brings significant economic burden on caregivers and healthcare systems. This study aims to estimate the long-term societal value of lecanemab plus standard of care (SoC) versus SoC alone, corresponding to a range of willingness-to-pay (WTP) thresholds based on the phase III CLARITY AD trial readouts from both the US payer and societal perspectives. METHODS An evidence-based model was developed to simulate the effects of lecanemab on disease progression in early AD using interconnected predictive equations based on longitudinal clinical and biomarker data derived from the Alzheimer's Disease Neuroimaging Initiative (ADNI). The model was informed with the results of the phase III CLARITY AD trial and published literature. Key model outcomes included patient life-years (LYs), quality-adjusted life-years (QALYs), and total costs of both the direct and indirect costs of patients and caregivers over a lifetime horizon. RESULTS Patients treated with lecanemab plus SoC gained an additional 0.62 years of life versus SoC alone (6.23 years vs. 5.61 years). The mean time on lecanemab was 3.91 years, and the treatment was associated with an increase in patient QALYs of 0.61 and an increase in total QALYs of 0.64 when both patient and caregiver utilities were considered. The model estimated that the annual value of lecanemab for the US payer perspective was US$18,709-35,678 ($19,710-37,351 for societal perspective) at the WTP threshold of $100,000-200,000 per QALY gained, respectively. Scenario analyses of patient subgroups, time horizon, input sources, treatment stopping rules, and treatment dosing were conducted to explore the impact of alternative assumptions on the model results. CONCLUSION The economic study suggested that lecanemab plus SoC would improve health and humanistic (quality of life) outcomes and reduce economic burden for patients and caregivers in early AD.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Eisai Inc., 200 Metro Blvd, Nutley, NJ, 07110, USA. .,McGill University, Epidemiology, Biostatistics, and Occupational Health, Montreal, QC, Canada.
| | - Weicheng Ye
- Evidence Synthesis, Modeling and Communication, Evidera Inc, Bethesda, MD, 20814, USA
| | - Aditya Sardesai
- Evidence Synthesis, Modeling and Communication, Evidera Inc, Bethesda, MD, 20814, USA
| | - Henri Folse
- Evidence Synthesis, Modeling and Communication, Evidera Inc, Bethesda, MD, 20814, USA
| | - Ameya Chavan
- Evidence Synthesis, Modeling and Communication, Evidera Inc, Bethesda, MD, 20814, USA
| | - Kang Kang
- Evidence Synthesis, Modeling and Communication, Evidera Inc, Bethesda, MD, 20814, USA
| | - Quanwu Zhang
- Eisai Inc., 200 Metro Blvd, Nutley, NJ, 07110, USA
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Affiliation(s)
- Sebastian Walsh
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Richard Merrick
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Edo Richard
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
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Tahami Monfared AA, Tafazzoli A, Ye W, Chavan A, Deger KA, Zhang Q. A Simulation Model to Evaluate the Potential Impact of Disease-Modifying Treatments on Burden of Illness in Alzheimer's Disease. Neurol Ther 2022; 11:1609-1623. [PMID: 35960495 PMCID: PMC9588111 DOI: 10.1007/s40120-022-00393-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION Alzheimer's disease (AD) is a progressive neurodegenerative disease that places a substantial burden on patients, caregivers, and society. The advent of disease-modifying treatments (DMTs) would represent a major advancement in the management of AD, particularly in early AD. It is important to understand the potential value of these therapies to individuals and society. METHODS A modeling framework was developed to estimate the potential clinical and economic burden of AD in the USA by simulating the impact, relative to that of usual care, of a DMT with hypothesized availability beginning from 2022. The model assessed AD epidemiology, disease progression, and burden of illness from 2020 to 2050. Model outcomes included the total number of Americans with mild cognitive impairment (MCI) due to AD and mild, moderate, or severe AD dementia in community or residential care settings and their associated care costs, including direct medical and non-medical costs for healthcare resource use and indirect costs for caregiving. RESULTS A hypothetical DMT was compared to the usual care under different effect scenarios based on delay in onset of AD (1, 3, and 5 years) and DMT uptake (25%, 50%, and 100%). A delay in the onset of AD by 5 years would reduce the prevalence of AD in 2050 by 6%, 12%, and 25%, resulting in savings of $0.783, $1.566, and $3.132 trillion from 2022 to 2050 for the 25%, 50%, and 100% uptake scenarios, respectively. CONCLUSION This analysis demonstrated that DMTs that provide even small delays in the onset of AD can lead to an increase in disease-free years and sizable savings in the cost of care, providing significant benefits to patients, caregivers, and society.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Eisai Inc., 200 Metro Blvd, Nutley, NJ, 07110, USA.
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
| | | | - Weicheng Ye
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | - Ameya Chavan
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | - Kristen A Deger
- Evidence Synthesis, Modeling and Communication, Evidera Inc., Bethesda, MD, 20814, USA
| | - Quanwu Zhang
- Eisai Inc., 200 Metro Blvd, Nutley, NJ, 07110, USA
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