Analysis of Costs for Imaging-Assisted Intervention in Alzheimer’s Disease with Lecanemab

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Abstract Submission 

Jarrad Perron¹, Carly Scramstad², Ji Hyun Ko²

¹University of Manitoba, Winnipeg, MB, ²University of Manitoba, Winnipeg, Manitoba

Jarrad Perron, MSc  
University of Manitoba
Winnipeg, MB

Carly Scramstad, MD  
University of Manitoba
Winnipeg, Manitoba

Ji Hyun Ko, PhD  
University of Manitoba
Winnipeg, Manitoba

Alzheimer's disease is the most common neurodegenerative disorder (Cao 2020). Lecanemab is an anti-amyloid drug that recently gained full FDA approval and demonstrated its ability to reduce cognitive decline and amyloid burden (Van Dyck 2023). The ability of physicians to effectively and ethically select candidates for anti-amyloid therapy remains an open question (Beach 2012). Dementia diagnosis is a complex process relying on medical history and neuropsychological exams (Arvanitakis 2019). Identifying prodromal AD in the mild cognitive impairment (MCI) stage is prohibitively difficult with current methods, but represents the most effective and efficient path for treatment, and so accurate discrimination between progressive (pMCI) and stable (sMCI) cases is crucial for early intervention in AD with anti-amyloid drugs. Diagnostic neuroimaging provides insight into AD progression, however clinical adoption of neuroimaging remains limited, with FDG-PET as the primary modality for differential diagnosis (Jack 2016, Minoshima 2021). Current practices lack specificity for the ethical use of anti-AD medications at the MCI stage. We explore neuroimaging's potential to predict forecast cognitive status in those with prodromal AD to cost-effectively and ethically evaluate candidates for anti-AD pharmaceutical therapy.

We are concerned with a discussion the potential costs of the first 3 years of mass prescription of lecanemab to patients with MCI per 1,000,000 people under a variety of scenarios. We examined the status quo scenario, a prophylactic scenario and multiple scenarios of different neuroimaging modalities at varying levels of sensitivity and specificity, and then compared costs of pharmaceutical intervention under a variety of pricing scenarios. All costs are calculated in 2020 USD. Monthly direct (patient-focused) and indirect (society-focused) costs are estimated for those with MCI and mild AD dementia were computed. Survival throughout the 3-year period and 90% efficacy for lecanemab treatment are assumed. Diagnosis for MCI per-subject cost are assumed to be $697 based on clinical experience. Local imaging program experiences suggest $2,000 for FDG-PET, $4,000 for amyloid PET, and $500 for MR imaging. Lecanemab's estimated annual cost is $26,500 and we assume moderate and large price adjustments of 20% and 65% in two different pricing scenarios.

With the status quo pricing of lecanemab at $26,500 annually, prophylactic anti-AD therapies is extremely expensive compared to status quo at $509,000 per positive outcome (preventing progression from MCI to dementia) every 3 years. The price anti-AD drugs is much larger than the savings introduced by their successful usage, however this is primarily driven by the cost of providing treatment to patients with prodromal AD who will not develop dementia (sMCI). Since these sMCI subjects represent the majority of those with MCI (77.7%) is it economical to exclude these as candidates for treatment. Total costs may be reduced to as low as $246,000 per positive outcome every 3 years using combined FDG-PET and MR imaging specifically due to its high specificity, however this is still prohibitively expensive compared to status quo of no treatment. In a scenario where cost of lecanemab is reduced by 65%, we see the same imaging modalities reducing the cost of treatment to $177,00, approximately $3,000,000,000 below cost of status quo per million patients.

We examined expected costs associated with public availability of lecanemab and how imaging-assisted pharmaceutical intervention can reduce costs in selecting appropriate candidates. The most cost-efficient outcome was determined to be a combination of FDG and MR neuroimaging studies at $177,000 for every positive outcome of preventing progression from MCI to dementia for 3 years, driven by the increase in assumed specificity, the lower cost of FDG-PET compared to amyloid-PET and a reduction in the annual cost of lecanemab to $9,275.

Neurodegenerative/ Late Life (eg. Parkinson’s, Alzheimer’s) ¹

Aging ²

Other Methods

Aging

Computational Neuroscience

Data analysis

Degenerative Disease

Machine Learning

Modeling

MRI

Positron Emission Tomography (PET)

STRUCTURAL MRI

Treatment