Value-based prices of emerging disease-modifying therapies for Alzheimer's disease in 174 countries: a cost-effectiveness and threshold analysis

Introduction: Countries have varying, limited healthcare budgets for emerging disease-modifying therapies. Cost-effectiveness analysis, combined with country-level cost-effectiveness thresholds, can be used to estimate value-based prices (VBPs) for lecanemab and donanemab across 174 countries. Methods: The cost-effectiveness of lecanemab and donanemab was estimated using incremental cost and quality-adjusted life years (QALYs) compared to usual care. Published cost-effectiveness thresholds were used to estimate VBPs of these drugs across 174 countries. Results: Compared to usual care, lecanemab and donanemab respectively increased average QALYs by 0.38 and 0.51. By country income status, VBPs for lecanemab and donanemab respectively ranged between $254 to $9434 and $387 to $13,964 (high income), $90 to $1025 and $137 to $1507 (upper middle income), $11 to $623 and $21 to $956 (lower middle income) and $4 to $18 and $9 to $32 (low income). Discussion: VBPs indicate how much 174 countries should be willing to pay. This framework can also be adapted and refined in the negotiation of country pricing.