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A hypothetical cohort of people with early symptomatic Alzheimer disease, consistent with TRAILBLAZER\u2010ALZ eligibility criteria: mean age 75\u2009years, amyloid\u2010\u03b2\u2010positive, with mild cognitive impairment or mild dementia because of Alzheimer disease and excluding individuals with\n                      <jats:italic>APOEE4<\/jats:italic>\n                      homozygotes, in line with the Australian labelling. Donanemab administered every 4\u2009weeks with magnetic resonance imaging (MRI)\u2010based amyloid\u2010\u03b2\u2010related imaging abnormalities monitoring and treatment suspension upon amyloid\u2010\u03b2 clearance or progression to severe Alzheimer disease, compared with standard care.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Incremental costs, quality\u2010adjusted life years (QALYs) and incremental cost\u2010effectiveness ratios (ICERs). Secondary analyses included sensitivity and distributional equity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Donanemab increased total healthcare costs ($300,689 vs. $178,121) and societal costs ($389,113 vs. $283,618) compared with standard care per capita, while improving health outcomes (4.38 vs. 4.01 QALYs) per capita. The ICER was $342,424 per QALY from the healthcare perspective and $294,701 per QALY from the societal perspective, exceeding frequently cited Australian willingness\u2010to\u2010pay thresholds. Sensitivity analyses identified drug cost and efficacy as key drivers of uncertainty. Distributional analysis suggested inequitable health gains by remoteness because of differences in diagnostic and treatment infrastructure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Donanemab provides clinical benefits but is unlikely to be cost\u2010effective under current Australian thresholds. Policymakers should balance economic evidence with unmet need, equity considerations and healthcare sustainability when making reimbursement decisions. Further research using real\u2010world evidence and disaggregated analyses by geography and socioeconomic status is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5694\/mja2.70186","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T07:15:59Z","timestamp":1776842159000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost\u2010Effectiveness of Donanemab for Early Alzheimer Disease in Australia"],"prefix":"10.5694","volume":"224","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9734-1140","authenticated-orcid":false,"given":"Lan","family":"Gao","sequence":"first","affiliation":[{"name":"Deakin University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosie","family":"Watson","sequence":"additional","affiliation":[{"name":"Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nawaf","family":"Yassi","sequence":"additional","affiliation":[{"name":"Royal Melbourne Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"World Health Organization \u201cDementia Fact Sheet \u201d(2023) https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/dementia."},{"key":"e_1_2_13_3_1","unstructured":"Australian Institute of Health and Welfare \u201cDementia in Australia: Summary \u201d(2023) https:\/\/www.aihw.gov.au\/reports\/dementia\/dementia\u2010in\u2010aus\/contents\/summary."},{"key":"e_1_2_13_4_1","unstructured":"Deloitte Access Economics \u201cThe Economic Impact of Dementia in Australia 2016\u20132056. 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