Yigit Vahit, Kalender Selin, Cetinturk Iskender
Faculty of Economics and Administrative Sciences, Health Management Department, Suleyman Demirel University, 32200, Isparta, Turkey.
Health Social Sciences Institute, Health Economics Doctorate Program, Suleyman Demirel University, 32200, Isparta, Turkey.
Cost Eff Resour Alloc. 2023 Aug 9;21(1):51. doi: 10.1186/s12962-023-00463-7.
Alzheimer's Disease (AD), the most common type of dementia, is a chronic, progressive, and neurodegenerative brain discomfort that causes the be damage to brain cells. Although there is no definitive treatment for AD, various drug treatments are used to reduce and control the symptoms of the disease. Developed for the treatment of mild-stage Alzheimer's patients, Aducanumab is the only drug approved by the Food and Drug Administration (FDA) in the past two decades. However, the cost is very high and, in many countries, Aducanumab has not been approved due to insufficient clinical efficacy and lack of evidence yet. This study aims to analyze the cost-effectiveness of Aducanumab, which was developed for the treatment of mild-stage AD, from the patient's perspective.
In the study, the Markov model was developed to determine the cost-effectiveness of Aducanumab compared to Standard of Care (SoC) therapy over a 5-year horizon. Cost and effectiveness data were taken from the literature. In the study, the discount rate was determined as 6%. The results were presented as the incremental cost-effectiveness ratio (ICER), which represents the cost per quality-adjusted life years (QALY). The results were retested with a one-way and probabilistic sensitivity analysis (PSA) due to possible uncertainties in the research parameters. The results were presented with the tornado diagram and the scatter plots.
With the Markov model, the total costs of Aducanumab and SoC treatments over a 5-year horizon were found to be 98.068 $ and 21.292 $, respectively. Aducanumab treatment had an incremental gain of 0.64 QALY and an incremental cost of 76.776 $ compared to the SoC treatment. The ICER value, which shows the additional cost per QALY of Aducanumab, was 119.408 $/QALY. As a result of the study, it was determined that Aducanumab was not cost-effective when compared to SoC treatment. Sensitivity analysis results showed stability against uncertainties. Aducanumab was confirmed not to be cost-effective with its current price and potential clinical benefit.
The result of the research is considered important in terms of providing evidence-based information on the cost-effectiveness of Aducanumab in Turkey. However, further, research is needed to evaluate Aducanumab's clinical efficacy and cost-effectiveness.
阿尔茨海默病（AD）是最常见的痴呆类型，是一种慢性、进行性神经退行性脑部疾病，会导致脑细胞受损。尽管AD尚无确切的治疗方法，但仍使用各种药物治疗来减轻和控制该疾病的症状。阿杜卡奴单抗是为治疗轻度阿尔茨海默病患者而研发的，是过去二十年来唯一获得美国食品药品监督管理局（FDA）批准的药物。然而，其成本非常高，而且在许多国家，由于临床疗效不足且缺乏证据，阿杜卡奴单抗尚未获批。本研究旨在从患者角度分析用于治疗轻度AD的阿杜卡奴单抗的成本效益。
在本研究中，开发了马尔可夫模型，以确定在5年时间范围内，与标准治疗（SoC）相比，阿杜卡奴单抗的成本效益。成本和效益数据来自文献。在研究中，贴现率确定为6%。结果以增量成本效益比（ICER）表示，即每质量调整生命年（QALY）的成本。由于研究参数可能存在不确定性，因此通过单向和概率敏感性分析（PSA）对结果进行了重新测试。结果通过龙卷风图和散点图呈现。
使用马尔可夫模型发现，在5年时间范围内，阿杜卡奴单抗和SoC治疗的总成本分别为98,068美元和21,292美元。与SoC治疗相比，阿杜卡奴单抗治疗的增量收益为0.64 QALY，增量成本为76,776美元。显示阿杜卡奴单抗每QALY额外成本的ICER值为119,408美元/QALY。研究结果表明，与SoC治疗相比，阿杜卡奴单抗不具有成本效益。敏感性分析结果显示对不确定性具有稳定性。阿杜卡奴单抗以其当前价格和潜在临床效益被证实不具有成本效益。
该研究结果对于提供关于阿杜卡奴单抗在土耳其成本效益方面基于证据的信息具有重要意义。然而，需要进一步研究以评估阿杜卡奴单抗的临床疗效和成本效益。
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