The social value of lecanemab for patients with early Alzheimer's disease in Japan

BackgroundLecanemab is the first approved disease-modified therapy in Japan for patients with mild cognitive impairment (MCI) due to Alzheimer's disease (AD) or mild AD dementia (AD-D).ObjectiveThis study aims to evaluate the social value of lecanemab in Japan.MethodsThe social value was evaluated using a cost-effectiveness model. The intervention was lecanemab added to the standard of care (SOC), and the comparator was SOC alone. The effect of lecanemab was determined based on the phase III trial and subsequent long-term follow-up observation studies. Health outcomes were quantified in life years and quality-adjusted life years (QALYs). Both patient and caregiver utilities were considered by summing the absolute values of utility for both the caregiver and patient. The base-case analysis was conducted from the public healthcare and long-term care payer's perspectives.ResultsLecanemab extended the time spent in early AD, thereby maintaining quality of life (QOL), reducing caregiver burden, and medical and long-term care resource usage. The incremental QALYs were 1.31 QALYs for MCI due to AD and 0.85 QALYs for mild AD-D, and the incremental cost-effectiveness ratios (ICERs) were JPY 8.5 million /QALY and JPY 7.9 million /QALY ($1 = JPY 150), respectively.ConclusionsThe value-based price or the ICER of lecanemab varied greatly depending on the perspectives and the methods of reflecting caregiver QOL. In AD, where the progression of the illness spans a long period and had a significant impact on families and society, narrowly defined value assessments were not sufficient, indicating the need to consider broader social value.