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Cost-effectiveness of testing biofluid biomarkers to diagnose Alzheimer's disease: a systematic review
Jiang H, Escamilla S, Beestrum M, Salas-Lucia F. European Journal of Health Economics, 2025-12-12
Topic: Amyloid, tau and blood-test diagnosis
Background Alzheimer's disease (AD) affects tens of millions of individuals and their families in the world. As AD progresses, the effectiveness of treatment declines, making a timely diagnosis crucial. One promising approach for timely diagnosis is testing biofluid biomarkers in patients' blood and cerebrospinal fluid (CSF). However, a comprehensive evaluation of whether these tests are cost-effective is missing. Here, we conducted a systematic review to assess the cost-effectiveness of testing biofluid biomarkers to diagnose AD. Method We searched PubMed, Embase, Cochrane Library, and Web of Science for studies published until October 2024. Studies were included if published in English, conducted an economic evaluation of CSF or blood biomarker testing to diagnose AD, and provided economic outcomes. We assessed the quality of studies using the CHEERS 2022 criteria. Results Nine studies were included: six evaluated CSF biomarker tests and three on blood biomarker tests. All studies used model-based simulations (decision trees or Markov models) rather than trial-based evaluations. CSF biomarker tests were mostly cost-effective compared to neurocognitive assessments or neuroimaging, while blood biomarker tests showed mixed results. Key cost-effectiveness contributors included AD prevalence, diagnostic accuracy, and treatment effectiveness. Studies met ~ 80% of the CHEERS criteria, with missing information on patient engagement. Conclusion Our review supports that biofluid biomarker testing could be cost-effective to diagnose AD. Given the lack of trial-based economic evaluations, model-based studies are a valuable starting point. Future evaluations should incorporate patient-centered outcomes and consider the emotional value and other socio-economic factors that affect patients and families suffering from AD.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Jiang, H., Escamilla, S., Beestrum, M., & Salas-Lucia, F. (2026). Cost-effectiveness of testing biofluid biomarkers to diagnose Alzheimer's disease: a systematic review. European Journal of Health Economics. https://doi.org/10.1007/s10198-025-01877-1
Vancouver
Jiang H, Escamilla S, Beestrum M, Salas-Lucia F. Cost-effectiveness of testing biofluid biomarkers to diagnose Alzheimer's disease: a systematic review. European Journal of Health Economics. 2026. doi:10.1007/s10198-025-01877-1. PMID: 41385058.
BibTeX
@article{jiang2026-41385058,
author = {Jiang, H. and Escamilla, S. and Beestrum, M. and Salas-Lucia, F.},
title = {{Cost-effectiveness of testing biofluid biomarkers to diagnose Alzheimer's disease: a systematic review}},
journal = {European Journal of Health Economics},
year = {2026},
doi = {10.1007/s10198-025-01877-1},
pmid = {41385058},
url = {https://doi.org/10.1007/s10198-025-01877-1}
}
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Key findings
- Results Nine studies were included: six evaluated CSF biomarker tests and three on blood biomarker tests.
- CSF biomarker tests were mostly cost-effective compared to neurocognitive assessments or neuroimaging, while blood biomarker tests showed mixed results.
Why it matters
This review found that CSF biomarker tests were mostly cost-effective compared to neurocognitive assessments or neuroimaging, while blood biomarker tests showed mixed results. All included studies were model-based simulations rather than trial-based evaluations, so these findings rest on modelled assumptions about prevalence, diagnostic accuracy and treatment effectiveness.
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Study details
- Study designsystematic-review
- Evidence strengthModerate
Limitations
All included studies were set in Europe or the US, limiting relevance elsewhere; only nine studies, all model-based with heterogeneous designs, were available, making generalisation difficult.
How this study scored 48/100
Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for sample size, effect reported and studied in people because the record does not state it. We have no data on free to read, so that was left out: it earned 47 of the 98 points we could judge it on, which is 48 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (European Journal of Health Economics) |
| Journal's citation record | 1 / 4 | The European Journal of Health Economics: journal h-index 96 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| 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 | 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 | A review of other studies — randomisation is not credited here |
| Times cited | 1 / 7 | Cited 2 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.0 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | 1 / 6 | Cited 0.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 2 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Federico Salas-Lucia: h-index 12 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Chicago: institution h-index 1,769 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41385058) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 47 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 47 of the 98 points we could judge it on is 48 out of 100. |
| Total | 48 / 100 | — |
What each of these 20 components measures, and what this score is not →
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