Access, Preferences, and Costs for Alzheimer’s Disease Treatment in Alabama (AccessAL-AD) - While promising for improving the lives of Alzheimer’s disease (AD) patients, new disease modifying drugs, like lecanemab, are expensive, require costly clinician assessment and brain imaging to determine eligibility, and are administered by intravenous infusion. These features may make new drugs prohibitively costly and potentially perceived as less worthy by patients of states like Alabama (AL), where poverty is widespread and medical resources are limited. To ensure that all Alabamians who may benefit from new AD drugs can have access to them, there is an urgent need to understand: 1) access to care challenges that contribute to the full cost of new drugs, i.e., cost that includes copayments for drugs, specialist visits and imaging, travel and productivity losses of clinic-based treatment, etc; 2) perceived value of new drugs, and 3) overall long-term costs and benefits of new drugs. The objective of this project is to address these knowledge gaps by conducting a mixed methods study and develop an economic analysis for estimating long-term costs and benefits of AD new drugs for older adults in AL. In a R61 planning phase (Year 1), we will conduct qualitative analyses to understand challenges of AD patients in 5 domains of access to care: Availability, e.g., of specialists, infusion clinics, imaging; Accessibility i.e., how easy it is to reach such medical resources; Affordability of drugs, specialist visits, imaging; Accommodation, i.e., how easy it is to use medical resources; and Acceptability, i.e., perceived benefits and side effects of new drugs, and preferences for treatment attributes including costs. These analyses will inform framing of the economic analysis, i.e., defining the analysis perspectives and costs and benefits to include under them. We will then develop a Markov model based on published models and set up data collection for its inputs. In the R33 phase (Years 2-5), we will collect model inputs using a survey of 240 patients and/or caregivers exposed to new (N = 80) and traditional AD drugs, and medical record abstraction for 120 patients who had visits with specialists (neurologists, psychiatrists, or geriatricians). Other inputs will be collected from the literature and public sources. Because access to care challenges, perceived new drugs’ value, and long term costs and benefits, may differ across patients’ groups, e.g., for African American (AA) and white patients, we will obtain base case estimates of costs and benefits, and run extensive sensitivity analyses to evaluate the robustness of results to the chosen model inputs, overall and for different AL populations. This work will occur under the guidance of a Patient/Caregiver and Provider Advisory Board (PPAB) to reflect the voice and relevant contexts of patients, caregivers, and providers in our findings. The PPAB will also help us define hypothetical interventions to enhance uptake of new drugs, for which we will examine cost-effectiveness using our economic model. Lastly, we will work with the PPAB to summarize results and develop recommendations for broadening use of new drugs in AL to disseminate to academic and non-academic audiences, including provider, patient and caregiver groups, and other stakeholders. In the supportive environment of the University of Alabama at Birmingham, with the proposed strong community engagement, the investigative team of this project will shed some light on the costs and benefits of new AD drugs, and contribute significantly to achieving broader use of these drugs among all older adults who may benefit from them, thus improving AD outcomes in a state like Alabama.
