Most health technology assessment (HTA) agencies measure treatment value as the benefits of reduced patient morbidity and mortality, and weigh these health benefits against incremental changes in treatment costs. A limitation of this approach, however, is that it may ignore broader societal values. For example, if the patient’s functional status improves, the time and cost burden for caregivers may be reduced; in addition, the patient himself can return to work; the public sector can save money by reducing the cost of public assistance (e.g., people with disabilities) .This broader element of value is defined by Radkavala et al. 2018 It creates an ISPOR “Flower of Value” of broader value elements. While these broader value elements may be of academic interest, it is unclear whether the magnitude of these effects is large.
Alzheimer’s disease is a disease that clearly affects caregiver burden, productivity, likelihood of enrolling in disability insurance, and a variety of other societal impacts that may not be directly captured when measuring the benefits of treatment on mortality and morbidity (usually using quality Adjusted Summary Life Year (QALY) indicator).A paper by Prados et al. (2022) Aiming to quantify the full societal value of new disease-modifying therapies for Alzheimer’s disease.
It was found that 63% of the treatment value was captured using the QALY-based standard approach. However, the remaining 37% of the value was missed due to reductions in nursing home costs, productivity, caregiver costs and avoidance of public assistance programs. However, nursing home and other cost reimbursements are often included in cost-benefit assessments, so the value that may be missed by the standard CEA framework may be closer to 20%.
However, in the graph above, the authors mention that this is a value that is particularly relevant for patients. People without Alzheimer’s disease may benefit from treatment because they are at risk for developing Alzheimer’s disease in the future. If they are risk averse, their value to disease-modifying treatment may be higher than the probability of disease multiplied by the QALY-based treatment value. In fact, the authors did find that much of the value of Alzheimer’s treatment comes from the benefits for those who don’t currently have the disease.
We quantify the value of disease-modifying AD treatments from the perspective of American society…as a lifetime value of $986 billion for the 2021 cohort of prevalent patients with MCI due to AD disease…we calculate an insured lifetime value of $4.52 trillion Unaffected adults (alive in 2021). The total social value is therefore estimated at $5.5 trillion, which is the combined value of the affected and unaffected populations in 2021, as the 2021 insurance value for the unaffected population already covers the value of those who develop symptoms later.
In short, about 82% of the therapeutic value comes from people who do not have Alzheimer’s and who are at risk of developing the disease in the future.This finding is similar to Shaflin et al. (2021) The paper found that 89.8% of the value of cancer treatment came from this generous insurance value.
