A Markov model compared lecanemab plus standard care with standard care alone in early Alzheimer's disease in China. Inputs came from 108 real-world patients at tertiary hospitals in South China, modelled over 20 years from a societal perspective. Lecanemab added 1.24 QALYs at an extra cost of 463,228 yuan, an ICER of 372,609 yuan per QALY. This exceeded the threshold of three times per-capita GDP, 298,995 yuan per QALY. The vial price would need to fall by at least 18.0%, from 2,508 to 2,057 yuan, to meet it. The authors state the base case favours lecanemab, because real-world treated progression was measured against a Western natural-history baseline.
Why it is interesting: Most lecanemab evaluations rely on Western trial data and payer costs. This one uses Chinese real-world progression and family caregiving costs, yet still finds the current price too high.
Abstract — the authors' own words, CC BY
Background
Although lecanemab has demonstrated clinical efficacy in early Alzheimer's disease (AD), its cost-effectiveness in China remains uncertain. This study evaluated the long-term cost-effectiveness of lecanemab in Chinese patients from a societal perspective and estimated its value-based price (VBP). Methods
A Markov state transition model based on Chinese real-world data was developed to compare the long-term health progression and economic outcomes of lecanemab combined with standard of care (SoC) versus SoC alone. Results
Compared to SoC alone, the lecanemab combination therapy gained an additional 1.2432 Quality-adjusted life years (QALYs) at an incremental cost of 463,228 Chinese yuan (CNY), resulting in an incremental cost-effectiveness ratio (ICER) of 372,609 CNY/QALY (≈ 52,783 USD/QALY). To achieve cost-effectiveness within the willingness-to-pay threshold, the price of a single vial of lecanemab must be reduced by at least 18.0%. Discussion
Lecanemab can provide health benefits to Chinese patients with early AD, but it is not cost-effective under the current pricing system.
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