Alzheimer's therapeutic breakthroughs may be financially inaccessible

Posted on: 13 May 2026

For decades, drug treatments for Alzheimer’s disease offered only limited symptomatic relief and did not alter the course of the disease. Two newer medicines, lecanemab and donanemab, now offer the possibility of slowing disease progression in early Alzheimer’s disease. However, these treatments will only make a meaningful difference if patients can access them. Around the world, every country has a different ability to pay for healthcare, meaning a price that may be affordable in one health system may be impossible in another.

A new study led by researchers at Trinity College in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, estimates the value-based prices of these medicines across 174 countries.

The research matters because AD is a major and growing global health challenge, and DMTs like lecanemab and donanemab are likely to place substantial pressure on health budgets. These new drugs may slow disease progression, but they are costly, require regular infusions, monitoring, and management of adverse events, and may not be affordable for many health systems at current prices.

Health economic researchers built a simulation model to follow people with early AD over their lifetime. The model compared what happens if they receive lecanemab or donanemab in addition to usual care, meaning the care they would otherwise receive without these new medicines.

Previous models used to inform pricing have generally focused on a single high-income setting. This new analysis provides estimates across 174 countries worldwide, including low- and middle-income countries where local cost-effectiveness evidence is often unavailable. This allows economists at Trinity to highlight not only whether these drugs are cost-effective, but also how affordability and value-based pricing need to differ across health systems globally.

Shutterstock / rafi ramada

Findings

The key finding is that, at currently emerging market prices, neither lecanemab nor donanemab would be considered cost-effective across the 174 countries examined.  This suggests that price may limit reimbursement and become a barrier to timely patient access.

The analysis also highlights a major global equity issue. Even when these medicines offer clinical benefit, the prices that would represent good value in low- and middle-income countries are far below prices currently seen in the US market. Without country-specific pricing, patients in many parts of the world may face long delays or no access at all.

What surprised researchers most was the size of the gap between current market prices and the prices that would be considered cost-effective. At current US market prices, lecanemab and donanemab exceeded their estimated value-based prices by 182% and 129%, respectively. While the US market may tolerate higher prices than many other health systems, most countries are likely to require substantial price reductions before these treatments can be reimbursed. The researchers warn that pricing, rather than clinical promise alone, may become one of the major barriers to timely patient access.

Dominic Trépel, PhD, Associate Professor (Health Economics), School of Medicine  (Psychiatry) / Global Brain Health Institute (GBHI), and Principal Investigator said:

 “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. Our study provides country-specific estimates of what these treatments could cost across 174 countries, giving health systems and manufacturers a practical starting point for fairer pricing, faster reimbursement decisions and more equitable access for people living with Alzheimer’s disease.

These new Alzheimer’s drugs are a scientific breakthrough, but they will only make a difference if people can actually access them. Our work shows what fair, affordable pricing could look like across 174 countries, helping to move the conversation from whether these drugs work to how health systems can deliver them.”

What is the impact of this research and who does it affect?

Health economics is often where scientific discovery meets real-world decision-making. These Alzheimer’s treatments may offer important benefits, but unless pricing and reimbursement decisions are informed by evidence, patients may wait years to access them. This work is intended to help shorten that gap between innovation and impact.

Several groups are affected: people with early AD and their families, clinicians, healthcare payers, policymakers, and pharmaceutical manufacturers. This research is relevant for countries with limited health budgets and limited capacity to conduct their own economic evaluations. For these settings, this study provides initial estimates and a framework that can support pricing discussions and future country-specific analyses.

To the researchers’ knowledge, this is the first global analysis estimating value-based prices of emerging disease-modifying therapies for AD across 174 countries. It builds on existing cost-effectiveness methods and published clinical trial evidence for lecanemab and donanemab.

Men Hoang, PhD candidate (Health Economics), School of Medicine (Psychiatry) and first author - supervised by Dominic Trépel for her doctorate in health economics – added: "Lecanemab and donanemab represent an important step forward in Alzheimer’s disease treatment, but our results suggest that substantial price reductions would be needed for them to be considered good value for money in most health systems worldwide."

What is the next step in this research? 

The next step is to offer this framework to Atlantic Fellows at GBHI, so that researchers and policy advocates can refine these estimates using country-specific data. The model also points to the need for future research to improve real-world evidence on long-term treatment duration, long-term effectiveness, safety, treatment discontinuation, and monitoring costs. As new evidence becomes available, the model can be updated to support faster and better-informed decisions about these treatments.

Further work is also planned to make the framework publicly available as an open-source model. The long-term aim is to provide a practical resource that dementia researchers, health systems and policy advocates can adapt to support evidence-informed decisions about dementia care, not only medicines.

READ: You can read the full paper: Value-based prices of emerging disease-modifying therapies for Alzheimer’s disease in 174 countries: a cost-effectiveness and threshold analysis at this link: https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.71308.

• Tags:
• Community
• Health
• Research