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Study weighs economic benefits of new Alzheimer’s treatments



This week, FDA is expected to grant accelerated access approval for an experimental Alzheimer’s medicine, lecanemab, that has successfully slowed progression of the disease. This and other promising new treatments could provide substantial benefits for patients and caregivers—but only if Medicare improves access to them.

Writing in RealClearPolicy, Tomas J. Philipson, former acting chairman of the President’s Council of Economic Advisers, and Yier Ling examine the economic benefits accrued with broader access to the new class of medicines. According to a study they published for the University of Chicago, “…slowing the transition from the mildest forms of Alzheimer’s to its more severe stages would greatly benefit the 6.5 million Americans afflicted by the disease as well as their caregivers. It would also ease the burden on Medicare, which in 2021 bore the lion’s share of $321 billion in health care spending for Alzheimer’s patients—and a chunk of the $272 billion in additional caregiver costs.

Unfortunately these benefits are far from assured. Under current Medicare policy, CMS, the agency that runs the program, requires drugmakers to generate additional evidence through studies before treatments will be covered for patients—even with FDA accelerated access approval. CMS has promised to reconsider this policy, but no firm plans have been disclosed.

With lecanemab nearing approval and other treatments in the pipeline, Philipson and Ling’s analysis adds depth to the cost-benefit equation that CMS must now consider:

Most debate has focused on the cost of approving these drugs because no robust assessments have examined the cost of not approving them — until now. In our analysis, we considered the value of a potential new therapy for Alzheimer’s that would slow patients’ progression from mild to moderate disease by six months to three years—the range of future gains considered by many discussions in peer-reviewed journals. Before people reach moderate disease, they are much more likely to be able to do activities key to remaining independent, such as shopping and cooking, maintaining appointments and hobbies, talking on the telephone, and discussing current events.

We found that a when patients transition from mild to moderate Alzheimer’s disease, their health care costs triple. We calculated a one-year delay of this transition would have a value to the U.S. of $200 billion to $1.3 trillion over the next 10 years where the range reflects different proportions assumed treated and the valuation of health gains. When we added in patients with an even earlier form of Alzheimer’s, known as mild cognitive impairment, and we conservatively assumed they would experience the same length of the delay as mildly affected patients, we found the overall value could expand to a range of nearly $300 billion to $1.8 trillion.

…Savings could be particularly large for Medicare, which covers nearly all Alzheimer’s patients and nearly half their total health care costs. We calculate Medicare would save up to $340 billion over a decade from innovations that delay patients’ transition from mild to moderate disease. Savings for patients with mild cognitive impairment could drive that number even higher.

You can read the full article at RealClearPolicy here.