Evaluation of the Cost-effectiveness of Drug Treatment for Alzheimer Disease in a Simulation Model That Includes Caregiver and Societal Factors

Abstract

IMPORTANCEThe possibility of widespread use of a novel effective therapy for Alzheimer disease (AD) will present important clinical, policy, and financial challenges. OBJECTIVE To describe how including different patient, caregiver, and societal treatment-related factors affects estimates of the cost-effectiveness of a hypothetical disease-modifying AD treatment. DESIGN, SETTING, AND PARTICIPANTS In this economic evaluation, the Alzheimer Disease Archimedes Condition Event Simulator was used to simulate the prognosis of a hypothetical cohort of patients selected from the Alzheimer Disease Neuroimaging Initiative database who received the diagnosis of mild cognitive impairment (MCI). Scenario analyses that varied costs and quality of life inputs relevant to patients and caregivers were conducted. The analysis was designed and conducted from June 15, 2019, to September 30, 2020. EXPOSURES A hypothetical drug that would delay progression to dementia in individuals with MCI compared with usual care. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. RESULTSThe model included a simulated cohort of patients who scored between 24 and 30 on the Mini-Mental State Examination and had a global Clinical Dementia Rating scale of 0.5, with a required memory box score of 0.5 or higher, at baseline. Using a health care sector perspective, which included only individual patient health care costs, the ICER for the hypothetical treatment was $192 000 per QALY gained. The result decreased to $183 000 per QALY gained in a traditional societal perspective analysis with the inclusion of patient non-health care costs. The inclusion of estimated caregiver health care costs produced almost no change in the ICER, but the inclusion of QALYs gained by caregivers led to a substantial reduction in the ICER for the hypothetical treatment, to $107 000 per QALY gained in the health sector perspective. In the societal perspective scenario, with the broadest inclusion of patient and caregiver factors, the ICER decreased to $74 000 per added QALY. CONCLUSIONS AND RELEVANCEThe findings of this economic evaluation suggest that policy makers should be aware that efforts to estimate and include the effects of AD treatments outside those on patients themselves can affect the results of the cost-effectiveness analyses that often underpin assessments of the value of new treatments. Further research and debate on including these factors in assessments that will inform discussions on fair pricing for new treatments are needed.

Projecting the long‐term societal value of a disease‐modifying treatment for Alzheimer's disease in the United States

“…The largest contribution to the value to afflicted persons was the valuation of an average of 0.75 per patient gain in QALYs, which is in line with recently published estimates of QALY gains of 0.73, 42 0.65, 43 and 0.225 5 assuming treatment effects of 25%, 31%, and 25%, respectively. The recently published Institute for Clinical and Economic Review report, which estimated a gain of 0.154 QALYs, did not disclose assumptions for treatment effect.…”

“…For caregivers, we estimate indirect cost based on losses in productivity and leisure time based on the GERAS data for community care costs 5 , 31 and Gustavsson et al. 30 for moderate and severe dementia patients in nursing homes.…”

“…Second, cost‐effectiveness analysis often only considers the value to the patient, 4 whereas a substantial part of the value of a treatment might accrue to family caregivers. 5 Hurd et al. estimated that between 31% and 49% of the attributable cost of dementia stems from lost caregiver productivity.…”

Amylin and Secretases in the Pathology and Treatment of Alzheimer’s Disease

“…However, there is a lack of randomized clinical trials on this purpose to date. Regardless, the cost effectiveness of this highly used diabetic medication creates great implementation potential for this agent [ 88 , 212 , 213 , 214 , 215 ].…”

Valuing Alzheimer Disease Therapies—Considering Costs and Benefits Beyond the Patient

“…With few exceptions, prior analyses have omitted caregiver quality-of-life effects because data are sparse, because the field lacks consensus on whether to include such consequences, and perhaps because payers have little incentive to consider caregiver outcomes that do not directly affect payer budgets. 2 When such effects are considered, most studies, including that by Ito et al, 1 simply sum patient and caregiver QALYs, but the approach raises questions-eg, it can be difficult for AD caregivers, who typically serve as proxy respondents for patients, to disentangle their own preferences from the patient's.…”