How to Overcome Global Price Barriers for New Alzheimer’s Drugs

In the last few years, progress has been made in the fight against Alzheimer’s disease with a class of therapies called anti-amyloid antibodies (anti-Aβ). These anti-Aβ therapies, like lecanumab (Leqembi) and donanemab (Kisulna) have been shown to slow progression of Alzheimer’s disease. However, the costs of these monoclonal antibodies are not affordable for many patients around the globe.

In a new analysis published May 13 in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, researchers from UC San Francisco and Trinity College Dublin, estimate the prices required in 174 nations for these new Alzheimer’s therapies to attain local willingness to pay for health gains. Their study suggests that only global price-setting would permit widespread benefit from these disease-modifying therapies.

The authors used the “value-based pricing” method to align the market price of the therapy with its estimated health benefits to the healthcare system and society and set a price that matches local ability to invest in these interventions. Their assessment examined a narrower health care perspective (considering only medical costs and excluding other factors like market returns) as well as a broader societal perspective.

“Given the current market prices of lecanemab and donanemab, they are unlikely to be cost-effective in all 174 countries,” said study senior author James G. Kahn, MD, MPH, emeritus professor at the UCSF Philip R. Lee Institute for Health Policy Studies and in the UCSF Global Brain Health Institute. “The threshold analysis provides prices for what these 174 countries could justify for these therapies, which would need to vary substantially by country.”

For example, the study found that for the U.S, the price required for lecanemab is $9,388 with the health care perspective, and $17,257 using the societal perspective. The comparable results for donanemab are $13,964 and $26,829. This compares with current list prices in the U.S. of $26,500 for lecanemab and $32,000 for donanemab. These findings suggest that price reductions of 16% to 35% would be needed to achieve the value-based pricing in the U.S. Lower prices would likely improve access and therefore use.

The value-based pricing is substantially less in low- and middle-income countries. In low-income countries, the target price is between $4 and $32 — representing price decreases of 97% to 99%. In lower-middle-income countries, the value-based price ranges from $11 to $956.

"Lecanemab and donanemab bring important health benefits, but at current market prices they are too expensive for most health systems worldwide," said study first author Men Thi Hoang, a health economics research associate at Manchester Centre for Health Economics and PhD candidate at Trinity College Dublin.

There is historical precedent for lowering costs for important new medications. In the early 2000s, the price for anti-retroviral therapy for HIV disease was decreased by 99% from U.S. levels for lower-income nations. The result was widespread uptake of these life-saving therapies.

"We learned 25 years ago with HIV drugs that transformative new treatments can be priced to reach people around the world,” said Kahn. “I hope the same happens with Alzheimer's medicines."

The authors say the study provides provisional value-based pricing estimates that can inform market access decisions. Importantly, their model offers a flexible framework that can be adapted and refined with country-specific data to inform drug price negotiations, and countries can enhance estimates with local data, which may reduce the uncertainty of decisions when setting drug prices.

Additional authors: Sanjib Saha, Dominic Trépel

Funding: This study was funded by the Global Brain Health Institute, Economics of Brain Health Project (Project 212322).

Disclosures: The authors declare no competing interests.