Evaluating the cost and benefit of amyloid pet scans and new Azheimer disease therapies: A financial and clinical perspective

The approval of new Alzheimer disease drugs, such as Kisunla™ (donanemab), represents a significant advancement in treating early symptomatic Alzheimer disease, including mild cognitive impairment. However, the cost associated with these treatments is substantial, raising important questions about accessibility and long-term affordability.

Cost of amyloid and tau PET scans

Amyloid and tau PET scans are crucial for diagnosing Alzheimer disease and determining eligibility for amyloid-targeting therapies like Kisunla. These scans are expensive, typically costing around $3,000 per scan without insurance. Although Medicare now covers multiple amyloid PET scans, patients generally pay 20% of the costs after meeting their deductible. These scans are necessary not only for initial diagnosis but also for monitoring the treatment's effectiveness over time, further adding to the overall cost.

Cost of Kisunla

Kisunla is administered as an intravenous infusion every 4 weeks, with the cost varying depending on the duration of treatment. A year of treatment with Kisunla costs approximately $32,000, but some patients may need to continue the treatment for up to 18 months, bringing the total cost closer to $48,696. However, Kisunla differs from similar drugs like Leqembi® in that treatment can be halted once PET scans show that amyloid plaques have been sufficiently cleared, which could reduce the overall cost for some patients.

Expected benefits

Kisunla has shown the ability to slow cognitive decline in patients with early Alzheimer disease, offering a delay in symptom progression by about 4 to 7 months compared to placebo. However, the benefits are modest and most pronounced in patients with the mildest symptoms and lower levels of tau protein. Importantly, Kisunla, like other amyloid-targeting drugs, does not reverse existing brain damage and comes with risks, including amyloid-related imaging abnormalities, which require careful monitoring through MRI scans.

Long-term considerations

Over a patient’s lifetime, the combined costs of PET scans, Kisunla treatment, and necessary monitoring could be substantial. These costs could be prohibitive for many patients, especially those on fixed incomes or with limited insurance coverage. The effectiveness of these treatments also depends on early intervention, which may not be accessible to all due to the high costs of diagnostic imaging and ongoing care.

Conclusion

Although the development of drugs like Kisunla is a promising step forward in treating Alzheimer disease, the high costs associated with these treatments present significant challenges. The healthcare system will need to address these financial barriers to ensure that the benefits of these advancements are accessible to all who need them.

MedLink acknowledges the use of ChatGPT-4, an Artificial Intelligence chatbot, in drafting this blog entry.

Are you interested in being a guest blogger for MedLink Neurology? Contact us at editorial@medlink.com.