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Cost-Effectiveness of Lecanemab for Individuals With Early-Stage Alzheimer Disease
Nguyen HV, Mital S, Knopman DS, Alexander GC. Neurology, 2024-03-14
Topic: Amyloid, tau and blood-test diagnosis
Plain-language summary
Background and objectives Little is known regarding the cost-effectiveness of lecanemab (Leqembi), a monoclonal antibody approved by the US Food and Drug Administration in January 2023 for the treatment of mild cognitive impairment (MCI) or mild dementia due to Alzheimer disease (AD). This study aims to quantify the cost-effectiveness of lecanemab and how it varies based on the accuracy of AD testing and individuals' APOE ε4 status. Methods Seven alternative test-treat-target strategies defined by combinations of testing approaches (PET, CSF, or plasma assay), treatment choices (standard of care [SoC] alone or lecanemab in addition to SoC), and targeting strategies (targeting APOE ε4 noncarriers or heterozygous patients or not) were compared. A hybrid decision tree-Markov cohort model was constructed with 5 states: (1) MCI (Clinical Dementia Rating-Sum of Boxes [CDR-SB] 0-4.5); (2) mild dementia (CDR-SB 4.6-9.5); (3) moderate dementia (CDR-SB 9.6-16); (4) severe dementia (CDR-SB >16); and (5) death. Effectiveness was measured by quality-adjusted life years and costs from third-party and societal perspectives were estimated in 2022 US dollars over a lifetime horizon. Results Among the 7 test-treat-target strategies, SoC alone was the optimal strategy from a cost-effectiveness perspective. Neither targeted lecanemab treatment nor treatment unrestricted by APOE ε4 genotype was cost-effective vs SoC alone, regardless of the test used to diagnose patients with early-stage AD. However, CSF assay followed by targeted treatment would become cost-effective if lecanemab is priced below $5,100 per year. These results were robust to the accuracy of diagnostic testing and rates of lecanemab discontinuation and adverse events. Discussion Neither targeted lecanemab treatment nor treatment unrestricted by APOE ε4 genotype is cost-effective vs SoC alone for patients with MCI or mild dementia due to AD. Lecanemab would be cost-effective in some settings if priced below $5,100 per year.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Nguyen, H. V., Mital, S., Knopman, D. S., & Alexander, G. C. (2024). Cost-Effectiveness of Lecanemab for Individuals With Early-Stage Alzheimer Disease. Neurology. https://doi.org/10.1212/WNL.0000000000209218
Vancouver
Nguyen HV, Mital S, Knopman DS, Alexander GC. Cost-Effectiveness of Lecanemab for Individuals With Early-Stage Alzheimer Disease. Neurology. 2024. doi:10.1212/WNL.0000000000209218. PMID: 38484190.
BibTeX
@article{nguyen2024-38484190,
author = {Nguyen, H. V. and Mital, S. and Knopman, D. S. and Alexander, G. C.},
title = {{Cost-Effectiveness of Lecanemab for Individuals With Early-Stage Alzheimer Disease}},
journal = {Neurology},
year = {2024},
doi = {10.1212/WNL.0000000000209218},
pmid = {38484190},
url = {https://doi.org/10.1212/WNL.0000000000209218}
}
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Key findings
- Results Among the 7 test-treat-target strategies, SoC alone was the optimal strategy from a cost-effectiveness perspective.
- These results were robust to the accuracy of diagnostic testing and rates of lecanemab discontinuation and adverse events.
Why it matters
In a US model comparing seven ways to test for, treat and target early Alzheimer's (MCI or mild dementia), adding lecanemab to standard care was not cost-effective. That held whichever test was used (PET, CSF or blood) and whether or not treatment was limited by APOE ε4 status. The authors estimate it would become cost-effective after a CSF test with targeted treatment if lecanemab cost less than $5,100 per year. This is a judgement about value for money at the 2022 price, not about whether the drug slows decline.
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Study details
- Study designmodelling
- Effect sizeLecanemab cost-effective only if priced below $5,100 per year
- Evidence strengthModerate
Limitations
Model-based, dependent on assumptions about long-term effect persistence and utilities; US price and payer perspective; does not include later real-world safety data.
How this study scored 61/100
Published in a leading specialty journal, and it is a computer model rather than new measurements. Scored zero for sample size, studied in people and randomized / blinded because the record does not state it. We have no data on free to read, so that was left out: it earned 60 of the 98 points we could judge it on, which is 61 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | 4 / 4 | Neurology: journal h-index 525 (OpenAlex, 2026-10-29) |
| Study design | 3 / 12 | A computer model rather than new measurements |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2024 — within 3 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 | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 78 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 19.5 citations a year over 4 year(s) since 2024 |
| Impact for its field and year | 5 / 6 | Cited 28.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 13 other studies in this library |
| Still being cited | 3 / 4 | Cited 78 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author G. Caleb Alexander: h-index 10 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,306 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 38484190) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 60 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 60 of the 98 points we could judge it on is 61 out of 100. |
| Total | 61 / 100 | — |
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May need a subscription Unpaywall, Europe PMC and OpenAlex found no free copy of the full text (checked 10 Oct 2026), so the publisher may charge for it. The PubMed abstract is free.
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