The Impact of Alzheimer’s Disease Treatments on Health Equity
Could health system changes that improve patient access to medication have a positive effect on societal welfare?
Data has shown that Alzheimer’s disease (AD) impacts historically marginalized groups disproportionately, including older adults from underrepresented racial and ethnic groups, especially those who are Black and Hispanic.1 These individuals have twice the risk of developing AD compared with White older adults—however, they are not only less likely to be given specialized care, but more likely to have a missed or delayed diagnosis.2 These factors are all prime examples of inequities when it comes to treatment access, economic concerns, and health outcomes.1,3
Given the development of new AD meds, there is now a push to understand their value with the help of cost-effectiveness analysis (CEA). Knowing this, an economic evaluation published in JAMA Network Open2 sought to take a deeper dive into the health equity impacts of disease-modifying treatments for AD.
Essentially, the goal was to assess the effect of a hypothetical treatment by examining its impact, while examining policies that can assist with tackling healthcare gaps.
The aforementioned economic evaluation occurred from June 16, 2022, to Jan. 11, 2024, utilizing a distributional cost-effectiveness analysis. The study followed Consolidated Health Economic Evaluation Reporting Standards (CHEERS) reporting guidelines, and consisted of subgroups that stratified by race, ethnicity, and social vulnerability quintiles in the United States.
Overall, the CEA simulated 316,037,100 individuals from the US population, consisting of 25 subgroups that were divided by five categories of race and ethnicity, along with social vulnerability population quintiles; the fifth and final quintile was considered the most socially vulnerable group.
Treatment was associated with improved population health, and in total, 28,197 quality-adjusted life-years (QALYs) per year were added to the US population at an opportunity cost benchmark of $150,000 per QALY. Treatment was also linked to a 0.009% reduction in existing population health inequalities yearly.
There are various limitations when it comes to this study, including the possibility of greater unpredictability between the subgroups that might not be accounted for in the original analysis. In fact, the investigators noted that they found “inadequate data quantifying racial and ethnic differences in the risk of institutionalization, direct medical costs, or caregiver impact.”
Further, data was limited for certain racial and ethnic groups, including Native Hawaiian and other Pacific Islander participants, which caused the authors to have to depend on literature-based subgroup approximations that matched these individuals with the Asian subgroup.
However, the investigators concluded that, “In this economic evaluation of disease-modifying treatment for AD, treatment was associated with modest improvements in societal welfare, with significant increases possible if disparities in AD diagnoses are reduced and access to timely treatment is expanded. As new AD drugs enter the US market, it will be important for decision-makers to evaluate how specific characteristics (eg, drug prices and clinical effectiveness) of novel therapies may change findings from this study and promote initiatives to facilitate earlier and more equitable access to care.”
References
1. Balls-Berry JJE, Babulal GM. Health disparities in dementia. Continuum (Minneap Minn). 2022;28(3):872-884.
2. Synnott PG, Majda T, Lin P, Ollendorf DA, Zhu Y, Kowal S. Modeling the Population Equity of Alzheimer Disease Treatments in the US. JAMA Netw Open. 2024;7(10):e2442353. doi:10.1001/jamanetworkopen.2024.42353
3. 2023 Alzheimer’s disease facts and figures. Alzheimers Dement. 2023;19(4):1598-1695. doi:10.1002/alz.13016
