For the first time in decades, the medical community has a tangible way to slow the progression of Alzheimer’s disease. But as new disease-modifying therapies hit the market, a stark divide is emerging between scientific possibility and patient reality. A new study suggests that significant price reductions for Alzheimer’s drugs are essential if these breakthroughs are to reach the millions of people who need them across the globe.
Research led by Trinity College Dublin analyzed the cost-effectiveness of two groundbreaking treatments—lecanemab and donanemab—across 174 countries. The findings reveal a systemic gap: while the drugs offer a historic opportunity to alter the trajectory of early-stage dementia, their current pricing models make them virtually inaccessible to health systems in most of the world.
The researchers concluded that without country-specific pricing strategies, patients in many regions face the prospect of long delays or a total lack of access. This creates a scenario where the “breakthrough” is limited to the wealthiest patients in the wealthiest nations, leaving the global majority behind.
The gap between market price and clinical value
The study focused on “value-based pricing,” a method that determines the cost of a drug based on the actual health benefit it provides to the patient relative to the cost of delivery. When measured this way, the current pricing in the United States appears disconnected from global economic realities.
According to the research, at current U.S. Market prices, lecanemab exceeds its estimated value-based price by 182 percent, while donanemab exceeds its value-based estimate by 129 percent. While the U.S. Healthcare market often absorbs higher costs, the researchers noted that most other national health systems cannot sustain such pricing without bankrupting other essential services.
Dominic Trépel, Associate Professor of Health Economics at Trinity’s Global Brain Health Institute (GBHI), emphasized that regulatory approval is only the first step. “After decades of disappointment in developing disease-modifying treatments for Alzheimer’s disease, new medicines are finally reaching the market. But approval alone does not guarantee access,” Trépel said.
The disparity is most acute in low- and middle-income countries (LMICs). The study found that most of these nations cannot afford an annual price above $100 for either drug. In contrast, only about 24 percent of countries can afford lecanemab and 30 percent can afford donanemab at a price point of $1,000 per year—all of which are high-income countries.
A crisis of reimbursement in high-income nations
The struggle for access is not limited to developing nations. Even in high-income countries with robust healthcare infrastructure, the cost of administration and monitoring is creating a barrier to reimbursement.
In Ireland, lecanemab was recently approved for use, yet the Health Service Executive (HSE) and private insurers have declined to fund the treatment. When the cost of the drug is combined with the necessary clinical administration and the rigorous monitoring required to manage side effects, the total cost is estimated at €60,000 per patient each year.
This creates a paradox where a drug is legally available and clinically indicated, but financially out of reach for the average citizen. This tension shifts the medical conversation from the efficacy of the science to the logistics of delivery.
| Metric | Lecanemab | Donanemab |
|---|---|---|
| U.S. Price vs. Value-Based Estimate | 182% Over Value | 129% Over Value |
| HIC Affordability (at $1,000/year) | ~24% of countries | ~30% of countries |
| LMIC Affordability Threshold | <$100/year | <$100/year |
Who benefits from these therapies?
To understand the pricing debate, it is necessary to look at who these drugs actually help. Lecanemab and donanemab are not cures for advanced Alzheimer’s; rather, they are designed for individuals with mild cognitive impairment or those in the early stages of dementia.
Clinical data indicates that lecanemab can slow the progression of the disease by approximately one-third on average over an 18-month period. For some patients, these benefits extend over several years, providing precious additional time in a state of higher cognitive function and independence.
However, the administration of these drugs is complex. They require regular infusions and frequent MRI scans to monitor for ARIA (amyloid-related imaging abnormalities), a potential side effect involving brain swelling or micro-hemorrhages. These ancillary costs are what often push the price beyond the reach of national health budgets.
Men Hoang, a PhD candidate at Trinity and the study’s first author, noted that while these drugs represent a massive step forward, the financial hurdle remains. “Our results suggest that substantial price reductions would be needed for them to be considered good value for money in most health systems worldwide,” Hoang said.
The path toward global health equity
The researchers suggest a tiered pricing model as a potential solution. In this framework, manufacturers would recoup their initial research and development investments by maintaining higher prices in high-income markets, such as the U.S. And Europe, while offering the drugs at near-cost or significantly reduced rates in LMICs.
This approach, the authors argue, makes economic sense for the manufacturers while ensuring that a patient’s geography does not determine their access to life-altering medicine. By providing country-specific value estimates, the study aims to give health ministers and pharmaceutical executives a practical starting point for negotiations.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Patients should consult with a licensed healthcare provider regarding the suitability of Alzheimer’s treatments for their specific condition.
The next critical phase for these therapies will be the ongoing reimbursement negotiations between national health boards and drug manufacturers. As more real-world data on long-term efficacy emerges, health systems will likely use this value-based evidence to push for the price reductions necessary to make these drugs a standard of care rather than a luxury.
Do you believe health systems should prioritize funding for these new treatments over other forms of care? Share your thoughts in the comments below.
