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

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.