Title: Reducing wasteful spending on discarded lecanemab in the U.S. Medicare program

Authors: Frank F. Zhou, AB; Chi-Hong Tseng, PhD; Mei Leng, MS; Benjo A. Delarmente, MD, PhD; Cheryl L. Damberg, PhD; Catherine A. Sarkisian, MD, MSHS; John N. Mafi, MD, MPH

Area of Concentration (Petal): Health Delivery Improvement Science

Specialty: Internal Medicine / Neurology

Keywords: Alzheimer's disease, lecanemab, healthcare waste

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Background:

Lecanemab is a newly approved, costly infusion drug for Alzheimer’s disease. Because lecanemab is weight-dosed and only available in 500 and 200 mg vials, leftover drug may lead to wasteful spending.

Objective:

We projected costs of discarded lecanemab in the U.S. Medicare program and modeled potential savings from using alternative vial sizes.

Methods:

We analyzed participants aged ≥65 years from the nationally representative 2020 Health and Retirement Study (HRS) who had Medicare Part B, and mild cognitive impairment or mild dementia.

For each patient, we determined their required weight-based dose, the most cost-efficient number of vials to provide that dose, and the resulting amount of drug wasted annually. After summarizing across our cohort and applying survey weights, we determined the average cost of wasted drug per-patient-per-year. Assuming lecanemab uptake rates of 1.2% to 3.0% from prior research,¹ we estimated the number of patients on lecanemab to generate total annual costs of discarded lecanemab.

To find alternative vial sizes with greatest potential savings, we performed 189 simulations replacing current vials with new sizes between 25 and 500 mg, and 7 simulations adding a third vial between 25 and 175 mg, excluding simulations requiring >4 vials per-patient-per-dose.

Results:

We identified 1,490 HRS participants potentially eligible for lecanemab, representing 7.2 million Americans. Current vial sizes could result in 5.8% of dispensed drug being wasted, representing $1,619 per-patient-per-year in wasteful spending and $141–356 million in total annually.

Among 109 eligible simulations of alternative vial sizes, adding a third 75 mg vial results in the greatest projected waste reduction, from 5.8% to 1.5%, representing $105–265 million in annual savings.

Conclusions:

We anticipate $141–356 million in annual wasteful spending on discarded lecanemab in the Medicare population.

Various policies could achieve savings. First, changing vial sizes could reduce wasteful spending by 70%. Second, legislative changes could compel manufacturers to reimburse Medicare for excess costs. Third, the U.S. could allow sharing vials between multiple patients.

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References:

¹ Arbanas JC, Damberg CL, Leng M, et al. Estimated Annual Spending on Lecanemab and Its Ancillary Costs in the US Medicare Program. JAMA Intern Med. 2023;183(8):885–889. doi:10.1001/jamainternmed.2023.1749