Medicare could waste up to $605 million a year on controversial Alzheimer’s drug aducanumab if it’s finally approved for widespread use because it comes in fixed-dose vials that may not be suitable for all patients, resulting in the destruction of large volumes of unused medication. drug, new research findings from UCLA.
The drug was found to have little or no benefit for patients with Alzheimer’s disease. Although Medicare has restricted the drug’s use in clinical trials, that decision could be overturned by an appeal or legal challenges. Previous research from UCLA found that the attendant care services associated with the drug alone could account for nearly 20% of Medicare costs for patients treated with the drug.
The researchers suggest that aducanumab, currently priced at $28,200 per patient per year, could be supplied in more efficient vial sizes to contain costs, if approved for general use.
“With several other Alzheimer’s drugs in the works, aducanumab won’t be the last infusion drug to threaten the Medicare budget,” said Dr. Carlos Irwin Oronce, assistant project scientist at the Division of General Internal Medicine and Health Services Research from UCLA. “Given the increase in Medicare premiums in 2022, in part due to aducanumab, a greater focus on efficient vial packaging could improve the value of future Medicare spending, slow premium growth, and reduce recipients’ disbursements. »
The article will be published on June 27 in the peer-reviewed journal Journal of the American Geriatrics Society.
The drug is available in fixed-dose vials – 170mg/1.7ml and 300mg/3.0ml – which are administered based on the patient’s weight and other factors such as amyloid plaque levels. Researchers used data from the 2016 Health and Retirement Study for participants aged 65 and older who are covered by Medicare Part B insurance and who had mild cognitive impairment (MCI) or dementia light.
For this analysis, the researchers assumed a monthly dose of 10 mg/kg of the drug. Based on the weight distribution of the study cohort, they defined 27 patient weight categories ranging from 47 kg or less (104 lb) to over 150 kg (330 lb). These categories reflected 27 possible combinations of aducanumab vials needed to correctly dose the drug for potentially eligible patients. The authors then subtracted the total amount of drug in the vials from the total amount of drug needed for each patient in the survey based on the patient’s weight. For example, an 85 kg patient requires 850 mg of drug supplied by three 300 mg/3.0 ml vials (900 mg total), with 50 mg of drug discarded per month. Based on the calculated wasted medicine for each patient in the nationally representative survey sample, the authors then estimated the potential amount of wasted medicine for the entire US Medicare patient population likely to receive of aducanumab each year.
If approved for widespread use and assuming 10% drug consumption, an estimated 132,000 to 694,000 vials of the expensive drug would be thrown away, a waste of $115 million to $605 million by Medicare and its enrollees. every year. Reducing the size of vials could reduce unnecessary expenses by 60%.
The study has some limitations, note the authors. For example, measures used to classify cognitive impairment may have misclassified some cases; plaque prevalence rates were derived from population-based studies and not from PET scans of study participants; and the authors assumed that the price of the drug would not change.
Additional study co-authors are Dr. John Mafi, Dr. Catherine Sarkisian, Julia Cave Arbanas, and Mei Leng of UCLA; Dr. Bruce Landon of Harvard University; and Cheryl Damberg of RAND Corporation. Oronce and Sarkisian have an appointment with the VA Greater Los Angeles Healthcare System and Mafi has an appointment with RAND.
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