Economic Evaluation of Lecanemab for Early Symptomatic Alzheimer's Disease in South Korea.

IF 2 Q2 ECONOMICS
Seungyeon Shin, Maryanne Kim, Song Hee Hong
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引用次数: 0

Abstract

Background/objectives: Alzheimer's disease (AD) exerts a considerable economic burden on South Korea's aging population. Lecanemab, an amyloid-targeting therapy, has demonstrated efficacy in mitigating cognitive decline in early-stage AD but remains non-reimbursed in South Korea due to concerns over its economic feasibility. This study aimed to examine the cost-effectiveness of lecanemab using nationwide claims data for cost estimation within the South Korean healthcare system. Considering the substantial societal burden of AD, we also evaluated the cost-effectiveness of lecanemab from a limited societal perspective.

Methods: A Markov state transition cohort model was developed to compare costs and outcomes of lecanemab combined with standard of care (SoC) versus SoC alone. The model simulated five stages of AD progression: mild cognitive impairment, mild AD, moderate AD, severe AD, and death. Transition probabilities between health states were derived from data provided by the National Alzheimer's Coordinating Center. Formal medical costs and long-term care costs were obtained from the national claims database, while drug cost and other medical expenses were derived from previous studies. Additional cost components such as opportunity cost of caregiver time, out-of-pocket expenses, and time and travel costs for hospital visits were included in the limited societal perspective. Korean-specific utilities for patients and caregivers differentiated by states of AD progression and care settings were obtained from the published literature. Effectiveness was measured in quality-adjusted life years (QALYs) over a lifetime horizon. Scenario analyses were conducted by varying compositions of the cohort, age of onset, and drug pricing.

Results: The incremental cost-effectiveness ratio (ICER) of lecanemab combined with SoC was 198,171,820 Korean Won (KRW)/QALY from the healthcare payer perspective and 181,185,820 KRW/QALY from the limited societal perspective, which significantly exceeded South Korea's willingness-to-pay (WTP) threshold of 30 million KRW/QALY. Sensitivity analyses revealed that the ICER was highly influenced by variations in treatment effect and discount rates. The result of scenario analyses suggested that targeting lecanemab to patients with mild AD or implementing price reductions could substantially improve its cost-effectiveness.

Conclusions: Lecanemab's high cost poses a challenge to its inclusion in the National Health Insurance formulary under South Korea's current WTP thresholds. Strategic price adjustments and patient targeting are essential to enhance its economic viability. These findings provide valuable insights for policymakers and stakeholders in balancing treatment outcomes and resource allocation for AD management.

韩国Lecanemab治疗早期症状性阿尔茨海默病的经济评价
背景/目的:阿尔茨海默病(AD)对韩国老龄化人口造成了相当大的经济负担。淀粉样蛋白靶向治疗药物Lecanemab在缓解早期AD患者认知能力下降方面已证明有效,但由于担心其经济可行性,在韩国仍未获得报销。本研究旨在使用韩国医疗保健系统内的成本估算的全国索赔数据来检查lecanemab的成本效益。考虑到阿尔茨海默病的巨大社会负担,我们也从有限的社会角度评估了lecanemab的成本效益。方法:建立马尔科夫状态转移队列模型,比较lecanemab联合标准护理(SoC)与单独标准护理(SoC)的成本和结果。该模型模拟了AD进展的五个阶段:轻度认知障碍、轻度AD、中度AD、重度AD和死亡。健康状态之间的转换概率来自国家阿尔茨海默病协调中心提供的数据。正式医疗费用和长期护理费用来自国家索赔数据库,而药品费用和其他医疗费用则来自以前的研究。额外的成本组成部分,如护理人员时间的机会成本、自付费用以及医院就诊的时间和旅行费用,都包括在有限的社会观点中。从已发表的文献中获得了针对不同AD进展状态和护理环境的患者和护理人员的韩国特定效用。有效性以生命周期内的质量调整生命年(QALYs)来衡量。通过不同的队列组成、发病年龄和药物定价进行情景分析。结果:lecanemab联合SoC的增量成本-效果比(ICER)分别为198,171,820韩圆/QALY和181,185,820韩圆/QALY,显著超过韩国的支付意愿(WTP)阈值3000万韩圆/QALY。敏感性分析显示,ICER受到治疗效果和贴现率变化的高度影响。情景分析的结果表明,针对轻度AD患者的lecanemab或实施降价可以显著提高其成本效益。结论:Lecanemab的高成本对其在韩国现行WTP门槛下被纳入国民健康保险处方集构成挑战。战略性价格调整和患者定位对于提高其经济可行性至关重要。这些发现为决策者和利益相关者平衡治疗结果和AD管理资源分配提供了有价值的见解。
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来源期刊
CiteScore
3.50
自引率
0.00%
发文量
64
审稿时长
8 weeks
期刊介绍: PharmacoEconomics - Open focuses on applied research on the economic implications and health outcomes associated with drugs, devices and other healthcare interventions. The journal includes, but is not limited to, the following research areas:Economic analysis of healthcare interventionsHealth outcomes researchCost-of-illness studiesQuality-of-life studiesAdditional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in PharmacoEconomics -Open may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.All manuscripts are subject to peer review by international experts. Letters to the Editor are welcomed and will be considered for publication.
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