Price reductions needed to make groundbreaking Alzheimer’s drugs available – study

Irish study of 174 countries finds that the real-world impact of innovative treatments will depend on whether they are priced in ways that health systems can afford

Most countries around the world are likely to require substantial price reductions before they will be able to reimburse groundbreaking new treatments for Alzheimer’s disease, new Irish research has found

A study led by Trinity College Dublin estimated the value-based prices of the drugs lecanemab and donanemab across 174 countries.

The medicines have been found to offer, for the first time, the possibility of slowing disease progression in early Alzheimer’s disease. However, the researchers concluded that, without country-specific pricing, patients in many parts of the world may face long delays, or no access at all to the breakthrough treatments.

“After decades of disappointment in developing disease-modifying treatments for Alzheimer’s disease, new medicines are finally reaching the market. But approval alone does not guarantee access,” said senior researcher Dominic Trépel, Associate Professor of Health Economics at Trinity’s Global Brain Health Institute (GBHI).

“Our study provides country-specific estimates of what these treatments could cost across 174 countries, giving health systems and manufacturers a practical starting point for fairer pricing, faster reimbursement decisions and more equitable access for people living with Alzheimer’s disease.

“These new Alzheimer’s drugs are a scientific breakthrough, but they will only make a difference if people can actually access them. Our work shows what fair, affordable pricing could look like across 174 countries, helping to move the conversation from whether these drugs work to how health systems can deliver them.”

The study found that, at currently emerging market prices, neither of the two drugs would be considered cost-effective across the 174 countries examined.

Even when these medicines offer clinical benefit, the prices that would represent good value in low and middle-income countries are far below prices currently seen in the US market.

At current US market prices, lecanemab and donanemab exceeded their estimated value-based prices by 182 per cent and 129 per cent, respectively.

While the US market may tolerate higher prices than many other health systems, the researchers said that most countries are likely to require substantial price reductions before these treatments can be reimbursed.

“Our study highlights significant disparities in drug prices across high, middle, and low-income countries, providing decision makers with value-based estimates to facilitate price negotiations,” the authors said.

“Assuming an annual price of $1000, approximately 24 per cent of countries can afford lecanemab and 30 per cent can afford donanemab, all of which are HICs (high income countries).

“Most low and-middle-income countries (LMICs) cannot afford prices above $100 annually for either drug.

“These findings suggest that the manufacturer may focus on recouping its up-front investments and earning a profit in HICs, such as the United States and Europe. It makes economic sense for wealthier countries to contribute more to drug innovation costs.”

In Ireland, lecanemab was recently approved for use, but insurers and the HSE have decided not to fund the treatment. Including the price of administering the drug and monitoring its effects, the treatment is estimated to cost €60,000 per patient each year.

Lecanemab is suitable for people with mild cognitive impairment or mild dementia due to Alzheimer’s disease. Research has shown that the drug can slow the progress of Alzheimer’s among eligible patients by about one-third on average over an 18-month period. However, some patients have experienced benefits lasting a number of years.

Men Hoang, Trinity PhD candidate and the study’s first author, said: “Lecanemab and donanemab represent an important step forward in Alzheimer’s disease treatment, but our results suggest that substantial price reductions would be needed for them to be considered good value for money in most health systems worldwide.”

Read the study: Value-based prices of emerging disease-modifying therapies for Alzheimer’s disease in 174 countries: a cost-effectiveness and threshold analysis – Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.