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. 2024 Dec;13(6):1641-1659.
doi: 10.1007/s40120-024-00649-y. Epub 2024 Sep 18.

Estimating the Economically Justifiable Price of Limited-Duration Treatment with Donanemab for Early Symptomatic Alzheimer's Disease in the United States

Malaz Boustani  1 , Erin G Doty  2 , Louis P Garrison Jr  3 , Lee J Smolen  4 , Timothy M Klein  4 , Daniel R Murphy  4 , Andrew W Spargo  2 , Mark Belger  5 , Joseph A Johnston  6
Affiliations

Estimating the Economically Justifiable Price of Limited-Duration Treatment with Donanemab for Early Symptomatic Alzheimer's Disease in the United States

Malaz Boustani et al. Neurol Ther. 2024 Dec.

Abstract

Introduction: The goal of this economic model is to estimate an economically justifiable price (EJP) for using donanemab for the treatment of early symptomatic Alzheimer's disease (AD) in the United States based on clinical data from the phase 3 TRAILBLAZER-ALZ 2 trial (NCT04437511).

Methods: We adapted an AD Markov state-transition model developed by the Institute for Clinical and Economic Review to estimate the EJP for donanemab at different willingness-to-pay (WTP) thresholds from the health care system perspective and the societal perspective as co-base cases.

Results: Assuming a WTP threshold of $150,000 per quality-adjusted life-year (QALY) gained, the model estimates a 1-year (13-dose) EJP for donanemab of $80,538 from the health care system perspective and $91,126 from the societal perspective; at a WTP threshold of $100,000 per QALY gained, the model estimates a 1-year (13-dose) EJP for donanemab of $44,691 from the health care system perspective and $55,419 from the societal perspective. Mean total treatment costs per patient at the $150,000 per QALY gained EJP derived from the health care system perspective were estimated at $77,812 based on the average number of doses of donanemab patients received in the co-base case analysis. One-way sensitivity analysis (OWSA) indicated that treatment efficacy, disease severity at the time of treatment initiation, and duration of treatment effect were the main drivers of the potential EJP.

Conclusions: Results from this modeling simulation informed by the TRAILBLAZER-ALZ 2 study support an EJP for limited-duration treatment with donanemab that exceeds per-dose list prices for currently available amyloid-targeting therapies, implying potentially lower lifetime costs and better value for money.

Keywords: Donanemab; Alzheimer’s disease; Amyloid-targeting therapies; Cost-effectiveness; Economically justifiable price.

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Conflict of interest statement

Malaz Boustani and Louis P. Garrison report fees from Eli Lilly and Company during conduct of this study. Erin G. Doty, Mark Belger, Andrew W. Spargo, and Joseph A. Johnston are employees and minor shareholders of Eli Lilly and Company. Lee J. Smolen, Timothy M. Klein, and Daniel R. Murphy are employees of Medical Decision Modeling Inc., which received compensation from Eli Lilly for the research that contributed to this article. The authors have indicated that they have no other conflicts of interest regarding the content of this article.

Figures

Fig. 1
Fig. 1
Model diagram. Patients are assumed to discontinue treatment upon progression to the severe dementia due to AD state. In the base case, 29.7% and an additional 36.4% of patients discontinue treatment because of amyloid plaque clearance at 6 and 12 months, respectively; 13.1% of patients stop treatment because of adverse events within the first 6 months of treatment. AD Alzheimer’s disease, MCI mild cognitive impairment
Fig. 2
Fig. 2
OWSA results for the co-base case from the health care system perspective. Tornado diagram depicting the impact on the donanemab 1-year (13-dose) EJP at the $150,000 per QALY gained WTP threshold for examined parameters. AD Alzheimer’s disease, BSC best supportive care, Com community-based care, EJP economically justifiable price, LTC long-term care, MCI mild cognitive impairment due to Alzheimer’s disease, Mild AD mild dementia due to Alzheimer’s disease, Moderate AD moderate dementia due to Alzheimer’s disease, OWSA one-way sensitivity analysis, QALY quality-adjusted life-year, Severe AD severe dementia due to Alzheimer’s disease, Tx treatment, WTP willingness-to-pay
See this image and copyright information in PMC

References

    1. Alzheimer's Association. 2023 Alzheimer’s disease facts and figures. Alzheimers Dement. 2023;19(4):1598–695. - PubMed
    1. Jack CR Jr, Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB, et al. NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease. Alzheimers Dement. 2018;14(4):535–62. - PMC - PubMed
    1. Biogen Inc. ADUHELM™ (aducanumab-avwa), US Prescribing Information. August 2023.
    1. Eisai Inc. LEQEMBI (lecanemab-irmb) US Prescribing Information. July 2023.
    1. Cummings J, Apostolova L, Rabinovici GD, Atri A, Aisen P, Greenberg S, et al. Lecanemab: appropriate use recommendations. J Prev Alzheimers Dis. 2023;10(3):362–77. - PMC - PubMed

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