Cost-effectiveness of Aducanumab, Donanemab for Alzheimer Disease

Relative to standard care, aducanumab and donanemab at their current expected prices are not cost-effective options for treating early Alzheimer disease (AD), according to findings published in JAMA Neurology.

Aducanumab (Aduhelm) was granted accelerated approval by the US Food and Drug Administration in June 2021. Donanemab is an investigational compound being studied in phase 3 trials. Both agents are anti-amyloid monoclonal antibodies for the treatment of AD.

“Considering the magnitude of AD’s effects, even an expensive treatment could yield immense health and economic gains,” study authors said, “but if its costs outweigh its clinical benefits, it could equally well exacerbate AD’s societal burden.”

Researchers created a model to understand health and economic outcomes for patients with early AD. Patients were 75.2 years of age on average, and 65% and 35% of patients had mild cognitive impairment and mild dementia, respectively. Outcomes were measured over a lifetime.

Simulated patients received standard care, aducanumab, or donanemab. Aducanumab was priced at $20,500 for the first year of treatment to account for dose titration, and $28,200 annually thereafter. Donanemab was assigned an annual cost of $28,200 for comparison.

Lifetime quality-adjusted life-years (QALYs) increased more with donanemab than aducanumab (.408 vs .133). Additionally, aducanumab was associated with greater total health care sector and societal costs ($130,100 and $127,800, respectively) compared to donanemab ($78,700 and $71,600, respectively).

Incremental cost-effectiveness ratios (ICERs) were also measured relative to standard care. Health care sector and societal ICERs were:

• $981,000/QALY and $964,000/QALY, respectively, for aducanumab; and
• $193,000/QALY and $176,000/QALY, respectively, for donanemab.

“In sensitivity analysis, aducanumab’s value-based price remained less than $50,000/year, even when assuming a 90% reduction in disease progression. Donanemab’s value-based price surpassed $50,000/year once its efficacy exceeded 50%,” researchers noted.

To become cost-effective, aducanumab would need to be priced at less than $3000 annually, researchers said. Donanemab was also not cost-effective at an expected price of more than $25,000 per year; however, in contrast to aducanumab, this agent could become cost-effective if priced at $20,000 per year.

Researchers recommended these findings be considered preliminary until donanemab’s efficacy is confirmed in phase 3 trials.

“The limited-duration dosing scheme used with donanemab is critical to its greater health-economic value; this approach may provide a rubric by which sufficiently effective anti-amyloid drugs could be economically viable in the US health care system, even when priced comparably to other biologics,” researchers said.

However, authors concluded, “at their current expected prices, neither aducanumab nor donanemab would be cost-effective for the treatment of early AD in the United States.”

Reference:
Ross EL, Weinberg MS, Arnold SE. Cost-effectiveness of aducanumab and donanemab for early Alzheimer disease in the US. JAMA Neurol. 2022;79(5):478-487. doi:10.1001/jamaneurol.2022.0315