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Publications

Journal Article Ppublish

PubMed: 40111937 DOI: 10.1177/13872877251323231

Cost-effectiveness of diagnosing and treating patients with early Alzheimer's disease with anti-amyloid treatment in a clinical setting.

J Alzheimers Dis 104(4):1167-1184

Authors: Anders Wimo, Ron Handels, Kaj Blennow, Bjørn-Eivind Kirsebom, Per Selnes, Jaka Bon, Andreja Emersic, Fernando Gonzalez-Ortiz, Milica Gregoric Kramberger, Anders Sköldunger, Andreja Speh, Santiago Timón-Reina, Ellen Vromen, Pieter Jelle Visser, Bengt Winblad, Tormod Fladby

Affiliations

  • Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, BioClinicum J9:20, Karolinska Institutet, Solna, Sweden.
  • Maastricht University, Alzheimer Centre Limburg, Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands.
  • Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, The Netherlands.
  • Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  • Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
  • Department of Neurology, University Hospital of North Norway, Tromsø, Norway. Department of Psychology, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway. Department of Neurology, Akershus University Hospital, Lørenskog, Norway. Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
  • Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
  • Department of Research, Akershus University Hospital, Lørenskog, Norway.
  • Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
  • Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia.
  • Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
  • Department of Nursing, Biologihuset, Umeå University, Umeå, Sweden.
  • Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
  • Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam UMC Location Vumc, Amsterdam, the Netherlands.
  • Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.
  • Department of Psychiatry, Maastricht University, Maastricht, the Netherlands.
  • Karolinska University Hospital, Theme Inflammation and Aging, Stockholm, Sweden.

Abstract

BackgroundThe introduction of anti-amyloid treatments (AAT) for Alzheimer's disease (AD) has put the cost-effectiveness into focus.ObjectiveEstimate the potential cost-effectiveness of diagnostic pathways combined with AAT for early AD.MethodsDiagnostic accuracy of blood-based (BBM) and cerebrospinal fluid (CSF) biomarkers was obtained from Norwegian memory clinics using positron emission tomography (PET) as reference standard. In a health-economic model, the cost-effectiveness of three diagnostic strategies was estimated relying either on BBM (p-tau 217), CSF (Aβ 42/40 ratio), and BBM with CSF confirmatory testing and compared with standard of care (SoC) and compared with CSF-AAT. The model consisted of a decision tree reflecting the diagnostic process and a subsequent Markov cohort model starting at mild cognitive impairment due to AD. All strategies except SoC were combined with AAT including costs of treatment (assumed €5000/year), infusions and monitoring.ResultsCompared with SoC all three strategies (CSF-AAT, BBM-AAT, and BBM-CSF-AAT) resulted in QALY gains at higher costs, with an incremental cost-effectiveness ratio (ICER) of 110k€, 141k€ and 110k€ respectively. Compared with CSF-AAT both BBM-AAT and BBM-CSF-AAT strategies resulted in QALYs lost at lower costs, with an ICER of 27k€ and 109k€ respectively. Results were particularly sensitive to the price of AAT and possible subcutaneous administration.ConclusionsCompared with SoC all three strategies are potentially not cost-effective as they exceeded the Swedish maximum willingness to pay threshold of €94,800 per QALY gained. BBM-CSF-AAT versus CSF-AAT is potentially cost-effective if willing to accept its QALY loss. Discussions on budget impact on different payers are needed after introducing AAT.

MeSH

Alzheimer Disease, Cognitive Dysfunction, Biomarkers, Quality-Adjusted Life Years, Therapeutics, Amyloid

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