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A Transferable Health Economic Evaluation Framework for Alzheimer’s Disease-Modifying Therapies
Sen SE.. Research Square, 2026-05-05
Topic: Drug trials: efficacy and safety
Base-case incremental cost-effectiveness ratios (ICERs) for lecanemab versus standard of care were €296,506 per QALY gained, and €371,299 per QALY for donanemab, from the HSE payer perspective under HIQA guidelines. Neither treatment met the €45,000/QALY willingness-to-pay threshold at current list prices. Five-year budget impact under the base-case uptake scenario was estimated at €48.7 million, with drug acquisition costs representing the largest cost category (42–58%) followed by diagnostic infrastructure (18%). The DCE module identified monitoring burden, out-of-pocket costs, and treatment location as dominant preference attributes. Probabilistic sensitivity analysis demonstrated that cost-effectiveness conclusions were most sensitive to drug price, treatment discontinuation rates, and the time horizon adopted. The R Shiny platform enabled identification of threshold drug prices at which DMTs become cost-effective, providing actionable evidence for pricing negotiations. This study provides a transferable health economic evaluation framework specifically designed for DMT assessment in small and medium healthcare systems, demonstrated through application to Ireland. The integrated CEA-BIA-DCE architecture, combined with the publicly accessible interactive platform, offers a replicable methodology that can be adapted to additional country contexts as DMTs progress through regulatory and reimbursement pathways. The framework directly addresses calls from recent service-readiness analyses for quantitative decision-support tools to complement qualitative implementation planning.
Key findings
- Base-case incremental cost-effectiveness ratios (ICERs) for lecanemab versus standard of care were €296,506 per QALY gained, and €371,299 per QALY for donanemab, from the HSE payer perspective under HIQA guidelines.
- Neither treatment met the €45,000/QALY willingness-to-pay threshold at current list prices.
- Five-year budget impact under the base-case uptake scenario was estimated at €48.7 million, with drug acquisition costs representing the largest cost category (42–58%) followed by diagnostic infrastructure (18%).
- The DCE module identified monitoring burden, out-of-pocket costs, and treatment location as dominant preference attributes.
- Probabilistic sensitivity analysis demonstrated that cost-effectiveness conclusions were most sensitive to drug price, treatment discontinuation rates, and the time horizon adopted.
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Study details
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 24 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 15 of the 62 points we could judge it on, which is 24 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (Research Square) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 15 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 15 of the 62 points we could judge it on is 24 out of 100. |
| Total | 24 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Sen, S. E. (2026). A Transferable Health Economic Evaluation Framework for Alzheimer’s Disease-Modifying Therapies. Research Square. https://doi.org/10.21203/rs.3.rs-9602832/v1
Vancouver
Sen SE. A Transferable Health Economic Evaluation Framework for Alzheimer’s Disease-Modifying Therapies. Research Square. 2026. doi:10.21203/rs.3.rs-9602832/v1.
BibTeX
@article{sen2026-e890aa4f,
author = {Sen, S. E.},
title = {{A Transferable Health Economic Evaluation Framework for Alzheimer’s Disease-Modifying Therapies}},
journal = {Research Square},
year = {2026},
doi = {10.21203/rs.3.rs-9602832/v1},
url = {https://doi.org/10.21203/rs.3.rs-9602832/v1}
}