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Value-based prices of emerging disease-modifying therapies for Alzheimer's disease in 174 countries: a cost-effectiveness and threshold analysis
Hoang MT, Kahn JG, Saha S, Trépel D. Alzheimer's & Dementia, 2026-05
Topic: Amyloid, tau and blood-test diagnosis
Introduction Countries have varying, limited healthcare budgets for emerging disease-modifying therapies. Cost-effectiveness analysis, combined with country-level cost-effectiveness thresholds, can be used to estimate value-based prices (VBPs) for lecanemab and donanemab across 174 countries. Methods The cost-effectiveness of lecanemab and donanemab was estimated using incremental cost and quality-adjusted life years (QALYs) compared to usual care. Published cost-effectiveness thresholds were used to estimate VBPs of these drugs across 174 countries. Results Compared to usual care, lecanemab and donanemab respectively increased average QALYs by 0.38 and 0.51. By country income status, VBPs for lecanemab and donanemab respectively ranged between $254 to $9434 and $387 to $13,964 (high income), $90 to $1025 and $137 to $1507 (upper middle income), $11 to $623 and $21 to $956 (lower middle income) and $4 to $18 and $9 to $32 (low income). Discussion VBPs indicate how much 174 countries should be willing to pay. This framework can also be adapted and refined in the negotiation of country pricing.
Key findings
- Methods The cost-effectiveness of lecanemab and donanemab was estimated using incremental cost and quality-adjusted life years (QALYs) compared to usual care.
- Results Compared to usual care, lecanemab and donanemab respectively increased average QALYs by 0.38 and 0.51.
Why it matters
This modelling study estimated value-based prices for lecanemab and donanemab across 174 countries based on cost-effectiveness and country-level thresholds, with lecanemab and donanemab increasing average QALYs by 0.38 and 0.51 respectively compared with usual care. It addresses how much countries should be willing to pay and does not itself establish that these therapies cure or prevent Alzheimer's disease.
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Study details
- Study designmodelling
- Effect sizeIncremental QALYs 0.38 (lecanemab) and 0.51 (donanemab) versus usual care; value-based prices $254-$9,434 and $387-$13,964 per year in high-income countries
- Evidence strengthModerate
Limitations
The model draws primarily on US data despite large differences in health systems, demographics and economics across countries; it assumes patients keep receiving treatment and benefit for as long as they remain in the MCI or mild AD stage, which may not reflect real-world patterns where benefit may be limited to an 18-month trial period or persist after stopping. Scenario analyses with 2-year treatment duration raised value-based prices roughly 2.5-fold.
How this study scored 43/100
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 randomised / blinded because the record does not state it. We have no data on free to read, so that was left out: it earned 42 of the 98 points we could judge it on, which is 43 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Alzheimer's & Dementia) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (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 | 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 | 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) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | 0 / 6 | Cited 0.0× 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 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Dominic Trépel: h-index 26 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California, San Francisco: institution h-index 1,915 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 5 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 42125995) |
| Free to read | — / 2 | Access not recorded — left out of this score |
| Points | 42 / 98 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 42 of the 98 points we could judge it on is 43 out of 100. |
| Total | 43 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — PubMed Central lists this copy as free to read: the link above (checked 10 Oct 2026).
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
Hoang, M. T., Kahn, J. G., Saha, S., & Trépel, D. (2026). Value-based prices of emerging disease-modifying therapies for Alzheimer's disease in 174 countries: a cost-effectiveness and threshold analysis. Alzheimer's & Dementia. https://doi.org/10.1002/alz.71308
Vancouver
Hoang MT, Kahn JG, Saha S, Trépel D. Value-based prices of emerging disease-modifying therapies for Alzheimer's disease in 174 countries: a cost-effectiveness and threshold analysis. Alzheimer's & Dementia. 2026. doi:10.1002/alz.71308. PMID: 42125995.
BibTeX
@article{hoang2026-42125995,
author = {Hoang, M. T. and Kahn, J. G. and Saha, S. and Trépel, D.},
title = {{Value-based prices of emerging disease-modifying therapies for Alzheimer's disease in 174 countries: a cost-effectiveness and threshold analysis}},
journal = {Alzheimer's \& Dementia},
year = {2026},
doi = {10.1002/alz.71308},
pmid = {42125995},
url = {https://doi.org/10.1002/alz.71308}
}
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