Cost-effectiveness of traditional and novel neurotherapeutic agents for Alzheimer's disease: A systematic review.

BackgroundSeveral monoclonal antibodies designed to slow cognitive and functional decline in individuals with early Alzheimer's disease (AD) have been recently approved. However, a comprehensive evaluation of the cost-effectiveness of all FDA-approved neurotherapeutic agents for AD remains lacking.ObjectiveThis study aimed to systematically review and analyze the incremental costs and effectiveness of currently available FDA-approved neurotherapeutic agents for AD to provide consolidated evidence on their economic value.MethodsA systematic review was conducted across PubMed, Embase, Cochrane CENTRAL, and Web of Science, adhering to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and PRISMA guidelines.ResultsTwenty-three articles were included. Most studies (74%) used a Markov model. Nearly half (48%) of studies were analyzed from both healthcare system and societal perspectives. Industry-funded studies made up 43%, while 39% were funded by non-profits, and 17% received no funding. Quality-adjusted life year (QALY) was the most common effectiveness measure (91%). At a willingness-to-pay (WTP) threshold of $100,000/QALY, all studies found memantine cost-effective, and more than half reported cost-effectiveness for donepezil, rivastigmine, and galantamine. Aducanumab, lecanemab, and donanemab were not cost-effective in any study. Under the WTP threshold of $150,000/QALY, value-based prices for aducanumab, lecanemab, and donanemab were estimated below $5,960, $15,700, and $33,700, respectively.ConclusionsTraditional symptom-targeting drugs were consistently cost-effective, whereas anti-amyloid therapies were not. Future independent cost-effectiveness analyses would benefit from head-to-head comparisons using real-world data and greater attention to disparities in dementia research.