Heterogeneity in cost-effectiveness analysis of vaccination for mild and moderate alzheimer’s disease

Chung Hsien Lin, Jean Ching Yuan Fann, Sam Li Sheng Chen, Hsiu Hsi Chen, Kuen Cheh Yang

Research output: Contribution to journalArticlepeer-review


Background: Immunotherapy for Alzheimer’s disease(AD) has gained momentum in recent years. One of the concerns over its application pertains to Cost-Effectiveness Analysis (CEA) from population average and specific subgroup differences, as such a therapy is imperative for health decisionmakers to allocate limited resources. However, this sort of CEA model considering heterogeneous population with risk factors adjustment has been rarely addressed. Methods: We aimed to show the heterogeneity of CEA in immunotherapy for AD in comparison with the comparator without intervention. Economic evaluation was performed via incremental CostEffectiveness Ratio (ICER) and Cost-Effectiveness Acceptability Curve (CEAC) in terms of the QualityAdjusted Life Years (QALY). First, population-average CEA was performed with and without adjustment for age and gender. Secondly, sub-group CEA was performed with the stratification of gender and age based on Markov process. Results: Given the threshold of $20,000 of willingness to pay, the results of ICER without and with adjustment for age and gender revealed similar results ($14,691/QALY and $17,604/QALY). The subgroup ICER results by different age groups and gender showed substantial differences. The CEAC showed that the probability of being cost-effective was only 48.8%-53.3% in terms of QALY at population level but varied from 83.5% in women aged 50-64 years, following women aged 65-74 years and decreased to 0.2% in men≥ 75 years. Conclusion: There were considerable heterogeneities observed in the CEA of vaccination for AD. As with the development of personalized medicine, the CEA results assessed by health decision-maker should not only be considered by population-average level but also specific sub-group levels.

Original languageEnglish
Pages (from-to)495-504
Number of pages10
JournalCurrent Alzheimer Research
Issue number6
Publication statusPublished - Jan 1 2019


  • Alzheimer’s disease
  • Cost-effectiveness analysis
  • Heterogeneity
  • Immunotherapy
  • Personalized medicine
  • Vaccination

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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