Potential cost-effectiveness of individualized medicine in prodromal Alzheimer's disease by demographic, clinical and cerebrospinal fluid proteomics factors

INTRODUCTIONThree distinct pathophysiological subtypes of Alzheimers disease (AD) have been identified based on CSF proteomics. We aim to estimate the potential incremental cost-effectiveness ratio of individualized hypothetical AD pharmacological treatment through stratification by these subtypes. METHODSIn a model-based health-economic evaluation usual care was compared to A) hypothetical treatment to in all subtypes and B) hypothetical treatment to those categorized as subtype 1 (high levels of BACE1) based on CSF proteomics; in a population of persons with MCI and positive amyloid and assuming hypothetical treatment efficacy in this subtype 1 only. RESULTSThe potential incremental cost-effectiveness ratio (ICER) was k{euro}36 per quality-adjusted life year (QALY) for strategy A (no subtyping test, hypothetical treatment in all subtypes) as compared to usual care, and k{euro}22 for strategy B (subtyping and hypothetical treatment for subtype 1 only) as compared to usual care. Compared to strategy A, strategy B was dominant, in terms of no difference in QALY and mean cost savings of k{euro}6 per person. DISCUSSIONGiven the assumptions in this study, individualized hypothetical AD pharmacological treatment of specific subgroups of AD patients, here based on a proteomics biomarker profile, has the potential to gain health-economic benefits. Future research should focus on retrospective analysis of trial data to generate empirical evidence on treatment effect between CSF proteomics subgroups.