This study modelled the lifetime cost-effectiveness of lecanemab and donanemab for early Alzheimer's disease in China. A Markov model compared each drug plus standard of care with standard of care alone, stratified by APOE ε4 genotype. Inputs included Chinese real-world costs, adverse events, discontinuation and benefit after stopping treatment. From the healthcare system perspective, ICERs were USD 309,841 per QALY for lecanemab and USD 232,794 for donanemab. Societal ICERs were USD 300,434 and USD 212,256 per QALY, all above the prespecified willingness-to-pay threshold. Donanemab's lower ICER depended on the assumed duration of residual treatment effect after discontinuation.
Why it is interesting: Neither anti-amyloid antibody met the prespecified willingness-to-pay threshold at current prices, from either perspective. The ranking between the two drugs rests on an assumption about how long benefit persists after treatment stops.
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