Cost-Effectiveness Analysis of Disease-Modifying Therapies for Early Alzheimer’s Disease in China

Lecanemab and donanemab are disease-modifying therapies for early Alzheimer’s disease, but their long-term economic value in China remains uncertain. This study evaluated their long-term cost-effectiveness in China. A lifetime Markov model compared lecanemab plus standard of care (SoC), donanemab plus SoC, and SoC alone from the Chinese healthcare system and societal perspectives. Treatment cohorts were stratified by apolipoprotein E ε4 genotype. The model incorporated Chinese real-world costs, treatment-related adverse events, discontinuation, and post-discontinuation benefits. Outcomes included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). One-way and probabilistic sensitivity analyses assessed parameter uncertainty, while scenario analyses examined drug prices, treatment populations, administration routes, and efficacy assumptions. From the healthcare system perspective, ICERs (in United States dollars [USD]) for lecanemab plus SoC and donanemab plus SoC were USD 309,841.194/QALY and USD 232,793.705/QALY, respectively. Corresponding societal ICERs were USD 300,434.358/QALY and USD 212,256.111/QALY. All estimates exceeded the prespecified willingness-to-pay threshold. The ICER for lecanemab was driven mainly by treatment efficacy and drug price, whereas donanemab was most sensitive to the duration of residual treatment effect. Varying the treatment-eligible population had limited impact on the ICERs. From the healthcare system perspective, ICERs ranged from USD 304,889.902 to USD 310,071.658/QALY for lecanemab and USD 211,226.601 to USD 240,400.661/QALY for donanemab; the corresponding societal ranges were USD 293,467.938–312,810.263/QALY and USD 204,513.613–214,437.087/QALY. At assumed United States prices for subcutaneous lecanemab, intravenous administration had a slightly lower ICER from the healthcare system perspective (USD 309,841.194/QALY versus USD 317,811.454/QALY), whereas all-subcutaneous administration had a slightly lower societal ICER (USD 298,027.332/QALY versus USD 300,434.358/QALY). Neither lecanemab nor donanemab was cost-effective at current Chinese prices. Patient selection had limited impact. The lower ICER for donanemab depended on the assumed residual treatment effect after discontinuation.