{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T00:44:44Z","timestamp":1793407484256,"version":"4.5.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Lecanemab is the second anti-amyloid-\n                      <jats:italic>\u03b2<\/jats:italic>\n                      monoclonal antibody to receive FDA approval for the treatment of early Alzheimer\u2019s disease (AD), following aducanumab. Unlike aducanumab, which faced restricted Medicare coverage, lecanemab received traditional approval in 2023, resulting in broader access through Medicare. Despite these developments, the comparative cost-effectiveness of lecanemab and aducanumab has not been fully established. This study aimed to assess whether lecanemab is more cost-effective than aducanumab in the management of early AD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An indirect comparison of cost-effectiveness was performed due to the absence of head-to-head randomized controlled trials. A five-state Markov model was constructed from the perspective of the US healthcare system with a lifetime horizon and a 1-year\u202fcycle length. Model outcomes included life-years (LYs), quality-adjusted life-years (QALYs), and costs, all discounted at an annual rate of 3%. Incremental cost-effectiveness ratios (ICERs) were calculated and compared with established willingness-to-pay (WTP) thresholds. One-way sensitivity analyses identified key drivers of model uncertainty, and a probabilistic sensitivity analysis (PSA) with 1,000 Monte Carlo simulations tested the robustness of the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incremental cost of the lecanemab group compared to the aducanumab group was $30,018.97, with an increase in quality-adjusted life-years (QALYs) of 0.25, resulting in an ICER of $121,678.49 per QALY gained. The result of the one-way sensitivity analysis showed that the utility of the state of mild dementia due to AD had the most important effects on the ICER of the lecanemab group compared to the aducanumab group. The probabilistic sensitivity analysis showed that lecanemab was more cost-effective than aducanumab across various WTP thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest that lecanemab provides greater value than aducanumab; however, at current list prices, neither drug is cost-effective compared with the standard of care. Price reductions are necessary to improve affordability, particularly for lecanemab, which is more widely covered by Medicare. Policy implications remain significant, as under the Inflation Reduction Act (IRA), biologics such as lecanemab are exempt from Medicare price negotiations for 13\u202fyears post-approval, limiting short-term opportunities for cost adjustment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1692508","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T06:42:14Z","timestamp":1769755334000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Lifetime cost-effectiveness of lecanemab for early Alzheimer\u2019s disease"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiangxiang","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina","place":["Columbia, SC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Medical Center of Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan E.","family":"Mendes","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina","place":["Columbia, SC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University","place":["Fort Lauderdale, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Yuan","sequence":"additional","affiliation":[{"name":"Institute of Chinese Medical Sciences, University of Macau","place":["Taipa, Macao SAR, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z. Kevin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina","place":["Columbia, SC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"ref1","volume-title":"Alzheimer's disease facts and figures","year":""},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.3233\/JAD-180903","article-title":"Present algorithms and future treatments for Alzheimer's disease","volume":"67","author":"Grossberg","year":"2019","journal-title":"J Alzheimer's Dis"},{"key":"ref3","volume-title":"Lexi-Drugs","year":""},{"key":"ref4","volume-title":"Lexi-Drugs","year":""},{"key":"ref5","volume-title":"Lexi-drugs","year":""},{"key":"ref6","doi-asserted-by":"publisher","first-page":"197","DOI":"10.14283\/jpad.2022.30","article-title":"Two randomized phase 3 studies of Aducanumab in early Alzheimer's disease","volume":"9","author":"Budd Haeberlein","year":"2022","journal-title":"J Prev Alzheimers Dis"},{"key":"ref7","volume-title":"FDA Grants accelerated approval for Alzheimer\u2019s drug","year":"2021"},{"key":"ref8","volume-title":"FDA converts novel Alzheimer\u2019s disease treatment to traditional approval","year":""},{"key":"ref9","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/s13195-021-00813-8","article-title":"A randomized, double-blind, phase 2b proof-of-concept clinical trial in early Alzheimer's disease with lecanemab, an anti-Abeta protofibril antibody","volume":"13","author":"Swanson","year":"2021","journal-title":"Alzheimer's Res Ther"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1056\/NEJMoa2212948","article-title":"Lecanemab in early Alzheimer's disease","volume":"388","author":"van Dyck","year":"2023","journal-title":"N Engl J Med"},{"key":"ref11","volume-title":"CMS finalizes Medicare coverage policy for monoclonal antibodies directed against amyloid for the treatment of Alzheimer\u2019s disease","year":""},{"key":"ref12","volume-title":"Statement: Broader Medicare coverage of Leqembi available following FDA traditional approval","year":"2023"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1001\/jamaneurol.2022.0315","article-title":"Cost-effectiveness of Aducanumab and Donanemab for early Alzheimer disease in the US","volume":"79","author":"Ross","year":"2022","journal-title":"JAMA Neurol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e968","DOI":"10.1212\/WNL.0000000000013314","article-title":"Cost-effectiveness and value-based pricing of aducanumab for patients with early Alzheimer disease","volume":"98","author":"Whittington","year":"2022","journal-title":"Neurology"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e12256","DOI":"10.1002\/trc2.12256","article-title":"Cost-effectiveness of aducanumab to prevent Alzheimer's disease progression at current list price","volume":"8","author":"Sinha","year":"2022","journal-title":"Alzheimers Dement"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e209218","DOI":"10.1212\/WNL.0000000000209218","article-title":"Cost-effectiveness of lecanemab for individuals with early-stage Alzheimer disease","volume":"102","author":"Nguyen","year":"2024","journal-title":"Neurology"},{"key":"ref17","volume-title":"Biogen to realign resources for Alzheimer's disease franchise","year":"2024"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1001\/jama.2016.12195","article-title":"Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and Medicine","volume":"316","author":"Sanders","year":"2016","journal-title":"JAMA"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"941","DOI":"10.1007\/s40120-021-00272-1","article-title":"Estimating progression rates across the Spectrum of Alzheimer's disease for amyloid-positive individuals using National Alzheimer's coordinating center data","volume":"10","author":"Potashman","year":"2021","journal-title":"Neurol Ther"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1159\/000265553","article-title":"Very mild to severe dementia and mortality: a 14-year follow-up - 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