Disparities in access to novel infusion treatment for Alzheimer’s disease revealed

The adoption of Lecanemab, a new infusion treatment for Alzheimer’s disease (AD), has been disproportionately higher in patients who are male, white, from urban areas, and have a higher socio -economic status, new research suggests.

The findings published in the Peer-Reviewed Jama Network OpenEmphasize how certain populations are more likely to have potential breakthrough new therapies than others, the researchers write.

Lecanemab was the first disease-modifying therapy that received broad medicine coverage for AD in July 2023. The drug is expensive, with a price tag of $ 26,000 a year and an estimated extra $ 7,000 per year in additional costs.

“This medicine contributes to increased Medicare expenditure for everyone, while he is only provided to a select number,” says Frank Zhou, a medical student at the David Geffen School of Medicine to the UCLA, who led the study. “These findings must warn policymakers that despite the programs for patient’s mound of the drug manufacturer to improve access to therapy, grim differences in admission have still taken place. While we are preparing for the likely future launch of more effective and safer therapies in this area, we must think of how to guarantee a harder to be able to guarantee from a voucher vitabele.”

The researchers analyzed all beneficiaries of Medicare Fee-For-Service who had received Lecanemab between 1 July 2023 and 31 March 2024. They compared the demography of these Lecanemab users with a wider population of patients who may be eligible for the drug by AD or mild cognitive disorders (MCI). Demographic variables for comparison include age, gender, race and ethnicity, urban/rural status and a proxy variable for socio-economic status, which was marked as “higher” if a patient was not eligible for the part D low incomes or for double Medicare-Medicaid. Within each demographic category, the recording speed of Lecanemab was calculated by dividing the number of Lecanemab users by the number of patients with AD or MCI.

Patients who used Lecanemab were more often male, white, from urban areas, and with a higher socio -economic status than those who did not do that, the researchers found. Of the 1,725 ​​Lecanemab users, 48.5% were male, 90.5% were white, 88.0% were urban inhabitants and 98.7% had a higher socio -economic status. Of all 842.192 patients with diagnosed AD of MCI, on the other hand, only 36.4% were male, 82.0% were white, 82.1% were urban residents and 75.3% had a higher socio -economic status.

The recording figures of Lecanemab were much higher for patients who were male (0.27% versus 0.19% for female), white (0.23% versus 0.09% for Asian/Pacific Islander, 0.04% for black, 0.07% for HISPANIC) and with a rural areas of land) and with a rural areas of land and areas of the areas of land and lands areas areas with a rural areas of land) and landed areas of the areas of land and lands. Social status (0.27% (0.27% for lower status (0.27% (0.27% for a lower status (0.27% for a lower status (0.27% for a lower status (0.27% for a lower socio -economic status).

We found that the adoption of Lecanemab was 6-time higher in white versus black patients and 24-time higher in patients with a higher versus lower socio-economic status. Although these findings may be related to the annual costs of the $ 26,000 drug and extensive test and visitors, they also reflect a broader and recurring historical pattern of inequalities in access to breakthrough therapies in the United States. “

Dr. John N. Mafi, Assistantial teacher-in-residence in the UCLA Division of General Internal Medicine and Health Services Research and the Co-Senior author of the study

A limitation of the research was that data for beneficiaries of Medicare Advantage were not available, the researchers write. In addition, patients with AD and MCI were identified via diagnostic codes, who can incorrectly diagnose or underestimate the prevalence of those disorders, cannot distinguish between different severity of AD and cannot take into account other criteria for the eligible for medication.

“Lecanemab is an expensive therapy with marginal clinical benefits and significant safety risks, and every decision to start using therapy must be discussed carefully with the doctor,” Zhou said. “In view of these important problems with therapy, Medicare also needs to analyze data from practice of his own register of Lecanemab users to decide whether continuous coverage of this therapy is suitable. This is especially striking, since there is probably better use for our limited Medicare Dollars, for example care provider for dementia patients.”

Study covers are Dr. Utibe Essien and Dr. Catherine Sarkisian van Ucla, Jeffrey Souza and Dr. Bruce Landon of Harvard University and Cheryl Damberg from Rand. The study was mainly funded by subsidies from the National Institute on Aging at the National Institutes of Health.