The Covid-19 pandemic is ending, but the Alzheimer’s epidemic is just beginning.
By the end of the decade, all baby boomers will be age 65 and older; there will be roughly 74 million American seniors — more than twice as many as 2000. In 2034, the number of seniors will exceed the number of children for the first time in American history.
This “gray tsunami” will result in an explosion of Alzheimer’s patients. The number of Americans with Alzheimer’s is expected to rise 40 percent by 2030 and double by 2050. The annual economic burden of the disease will grow from $355 billion today to approximately $1 trillion by the middle of the century.
Enter Aduhelm, the first new medication to treat Alzheimer’s in a generation, approved this month by the Food and Drug Administration. The drug is the first to address the underlying cause of the disease, reducing amyloid plaques in the brain. In clinical trials, patients taking Aduhelm had 25 to 28 percent less cognitive decline after 78 weeks than their control counterparts.
This breakthrough offers hope for the Alzheimer’s community and the nation on the precipice of an Alzheimer’s epidemic. I can speak firsthand on this issue. My stepmother has Alzheimer’s, and I am her part-time caregiver. She is still in the early stages of the disease, but it’s already clear she cannot live by herself.
Even limited caregiving has already taken a toll on my family. I worry about what the next several years will hold as the disease progresses. According to the Alzheimer’s Association, 59 percent of family caregivers rate their emotional stress as high or very high.
Aduhelm helps patients in the early stages of this disease, but I’m unsure whether my stepmother will qualify. Yet, the medication may still help patients who aren’t eligible by ushering in the investment needed to identify and develop additional treatments and (one day) a cure. More than 70 other potential Alzheimer’s medications in the clinical pipeline, and this approval could give the most promising a boost across the finish line.
Alzheimer’s can follow in the footsteps of other diseases like Duchenne muscular dystrophy, rheumatoid arthritis, and multiple sclerosis that have seen a slew of new treatments approved in short succession following an initial breakthrough.
Activist groups like the Institute for Clinical and Economic Review (ICER) have criticized Aduhelm’s approval, claiming the medication is grossly overpriced. On July 15, ICER will hold closely-watched hearings to inform its ensuing final value assessment of the drug. Based on its preliminary estimates, this report will likely claim Aduhelm is too expensive and advise Medicare not to cover it.
Yet ICER’s value metric, which measures drugs’ impact on patients’ quality of life years (QALY), is simplistic. It fails to account for the intangible quality of life considerations such as patient dignity and time spent with loved ones. It also doesn’t consider the tremendous benefits medications offer caregivers and the broader economy. This giant asterisk is needed beside any ICER conclusion, especially its upcoming Alzheimer’s finding.
At first glance, Aduhelm’s annual list price of $56,000 is expensive. Yet Medicare does not pay sticker prices. It pays average sales prices, which are often around half as much. This lower, actual price must cover the billions of dollars of sunk costs on the many failed Alzheimer’s drugs that preceded this one while incentivizing more investment to discover new treatments.
Even looking at the average sales price alone is simplistic. To the extent that Aduhelm can help patients like my stepmother maintain their autonomy and stay out of nursing homes and keep caregivers like me at work, it offers a net benefit for the health care system and the broader economy.
The Alzheimer’s epidemic is still in its infancy. There remains time to ward off the worst ravages of it. But to do so, Americans must support new treatments like Aduhelm, which isn’t a panacea but may end up being the moment the scientific community turned the corner on treating this brutal disease.
* Terry Wilcox is the executive director of Patients Rising.