Cost-Effectiveness of Lecanemab for Individuals With Early-Stage Alzheimer Disease.

Autor:	Nguyen HV; 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., Mital S; 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., Knopman DS; 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., Alexander GC; 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.
Jazyk:	angličtina
Zdroj:	Neurology [Neurology] 2024 Apr 09; Vol. 102 (7), pp. e209218. Date of Electronic Publication: 2024 Mar 14.
DOI:	10.1212/WNL.0000000000209218
Abstrakt:	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.
Databáze:	MEDLINE
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