Cost-effectiveness of traditional and novel neurotherapeutic agents for Alzheimer's disease: A systematic review

Background Several monoclonal antibodies designed to slow cognitive and functional decline in individuals with early Alzheimer's disease (AD) have been recently approved. However, a comprehensive evaluation of the cost-effectiveness of all FDA-approved neurotherapeutic agents for AD remains lacking. Objective This study aimed to systematically review and analyze the incremental costs and effectiveness of currently available FDA-approved neurotherapeutic agents for AD to provide consolidated evidence on their economic value. Methods A systematic review was conducted across PubMed, Embase, Cochrane CENTRAL, and Web of Science, adhering to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and PRISMA guidelines. Results Twenty-three articles were included. Most studies (74%) used a Markov model. Nearly half (48%) of studies were analyzed from both healthcare system and societal perspectives. Industry-funded studies made up 43%, while 39% were funded by non-profits, and 17% received no funding. Quality-adjusted life year (QALY) was the most common effectiveness measure (91%). At a willingness-to-pay (WTP) threshold of 100, 000/QALY, all studies found memantine cost-effective, and more than half reported cost-effectiveness for donepezil, rivastigmine, and galantamine. Aducanumab, lecanemab, and donanemab were not cost-effective in any study. Under the WTP threshold of 150, 000/QALY, value-based prices for aducanumab, lecanemab, and donanemab were estimated below 5, 960, 15, 700, and 33, 700, respectively. Conclusions Traditional symptom-targeting drugs were consistently cost-effective, whereas anti-amyloid therapies were not. Future independent cost-effectiveness analyses would benefit from head-to-head comparisons using real-world data and greater attention to disparities in dementia research.