A recent study has revealed significant disparities in the adoption of lecanemab, a newly introduced infusion therapy for Alzheimer’s disease (AD). According to findings published in JAMA Network Open, males, white individuals, urban dwellers, and those with higher socioeconomic status are more likely to receive this treatment. This highlights broader inequities in accessing groundbreaking therapies within the U.S., despite efforts by manufacturers to enhance accessibility through assistance programs. The drug, which became the first disease-modifying therapy covered broadly by Medicare in July 2023, remains controversial due to its limited efficacy in slowing cognitive decline and associated risks such as brain bleeding.
The introduction of lecanemab into Medicare coverage has sparked debates about equitable access to costly medical treatments. Frank Zhou, a medical student at UCLA who led the study, noted that while the drug increases overall Medicare spending, it only benefits a select group of patients. Analyzing data from July 2023 to March 2024, researchers compared demographics of lecanemab users against a wider population diagnosed with AD or mild cognitive impairment (MCI). Key demographic variables included age, gender, race, ethnicity, urban/rural residence, and socioeconomic status.
Findings indicated that among the 1,725 lecanemab users studied, a disproportionate number were male (48.5%), white (90.5%), urban residents (88.0%), and possessed higher socioeconomic status (98.7%). In contrast, within the larger cohort of 842,192 patients with diagnosed AD or MCI, these figures were significantly lower. Adoption rates were notably higher among males, whites, urban populations, and individuals with higher socioeconomic standing.
Dr. John N. Mafi, co-senior author of the study, pointed out that lecanemab adoption was six times higher among white versus Black patients and twenty-four times higher among those with higher versus lower socioeconomic status. These disparities may stem not only from the drug's high cost but also reflect historical patterns of inequitable access to advanced treatments in the United States.
Limitations acknowledged by the researchers include unavailable data for Medicare Advantage beneficiaries and potential inaccuracies in diagnosis codes used to identify eligible patients. Furthermore, the study emphasizes that given the marginal clinical benefits and safety concerns of lecanemab, careful discussions with healthcare providers should precede its use. There is also a call for Medicare to evaluate real-world data to determine if continued coverage is justified, considering alternative uses for limited funds, such as caregiver support for dementia patients.
Collaboration on the study involved multiple institutions, including UCLA, Harvard University, and RAND Corporation, with primary funding provided by the National Institute on Aging at the National Institutes of Health. The research underscores the need for equitable distribution of innovative yet expensive therapies like lecanemab, ensuring all eligible patients can benefit regardless of their background or financial means.