A preliminary economic evaluation of a potential program for the primary prevention of Alzheimer’s disease

We evaluated the potential cost-effectiveness of a hypothetical primary prevention screening and treatment program to avert the biological and clinical onset of Alzheimer's disease (AD) in cognitively unimpaired older adults. This hypothetical program would use an amyloid plaque-clearing antibody therapy monthly in the first six months and annually thereafter in cognitively unimpaired 55-79 year-old APOE4 carriers and 60-79 year-old non-carriers with a negative AD blood test (sensitivity and specificity of 0.9), averting the onset of moderately frequent neuritic amyloid plaques by 75 %. Lifetime hypothetical treatment outcomes were compared to natural history outcomes to estimate cost-effectiveness. The program would be cost-effective up to a per-dose price of $1173 in APOE4 carriers and $307 in non-carriers or a lifetime cost of $20,167 and $5146, respectively. Primary AD prevention could be cost-effective in older adults, especially in those at higher risk. Our findings and assumptions need to be confirmed with actual data.