Cost-effectiveness of aducanumab to prevent Alzheimer's disease progression at current list price

Abstract

Introduction: An estimated 6 million Americans have Alzheimer's disease (AD). Aducanumab was recently approved by the Food and Drug Administration despite the lack of clinical effectiveness data. Methods: We developed a Markov state transition model of AD to estimate the cost effectiveness of aducanumab compared to standard of care (SOC) over a 5-year time horizon for a cohort of persons aged 65 with mild AD. Outcomes included quality adjusted life years (QALYs), discounted costs, and incremental cost-effectiveness ratios (ICERs). We performed sensitivity analyses to address uncertainty. Results: Over 5 years, the incremental cost of aducanumab compared to SOC was $179,890. Aducanumab resulted in 0.47 QALYs gained compared to SOC. The ICER for aducanumab compared to SOC was $383,080/QALY. In threshold analysis, aducanumab became cost-effective at $22,820/year. Discussion: Aducanumab is not cost-effective at the estimated price of $56,000 even under ideal circumstances in which it completely halts AD progression.