Collaborative care for Alzheimer’s disease (AD) may deliver greater health gains at lower cost than the antiamyloid drug lecanemab when implemented nationwide, results of a new cost-effectiveness analysis show.

Replacing usual care with collaborative dementia care was associated with gains in quality-adjusted life years (QALYs) — a measure of both survival and health-related quality of life — and generated substantial net savings. Collaborative dementia care relies on paid care navigators to coordinate with clinical teams and connect caregivers to community resources.

Lecanemab also improved outcomes, but at a high cost per QALY gained. When the two approaches were combined, health gains increased further, but the cost per QALY compared with collaborative care alone exceeded commonly accepted cost-effectiveness thresholds.

“The message for health systems is not that disease-modifying therapies don’t matter — they do — but that they work best when paired with strong supportive care,” study co-author Katherine Possin, PhD, with the Fein Memory and Aging Center, University of California San Francisco (UCSF), told Medscape Medical News.

“Many clinics are investing heavily to deliver new Alzheimer’s drugs. Our work suggests this is also a moment to build the care infrastructure patients and families need alongside those treatments,” she added.

“Collaborative dementia care can improve outcomes for families and may offset some of the downstream costs associated with dementia care,” said first author Kelly Atkins, DPsych, formerly with the UCSF Fein Memory and Aging Center, now at Monash University, Melbourne, Australia.

The study was published online on February 5 in Alzheimer’s and Dementia: Behavior and Socioeconomics of Aging.

Transforming AD Care

The investigators developed a Markov chain health state transition model simulating outcomes for a cohort of 1000 adults whose age, sex, and disease stage at entry mirrored the CLARITY AD trial cohort. The cohort had a mean age of 71 years, 52% were women, 55% had mild cognitive impairment due to AD, and 45% with mild dementia due to AD.

They modeled three scenarios: 18 months of lecanemab, collaborative dementia care, and a combined approach delivering both interventions according to patients’ clinical stage.

Treatment with lecanemab increased survival and time spent in the community, but at a substantial additional cost. Compared with usual care, 18 months of therapy yielded an additional 0.17 life-years, 0.18 community years, and 0.17 QALYs per person, while increasing costs by approximately $38,500 from the healthcare perspective. The incremental cost-effectiveness ratio (ICER) was $225,500 per QALY from the healthcare perspective and $203,000 per QALY from the societal perspective.

Collaborative care improved quality of life without extending survival and generated substantial cost savings. Compared with usual care, it increased QALYs by 0.26 and added 0.34 years in the community, while reducing healthcare costs by about $48,000 per person — largely through Medicare savings and delayed long-term care placement. From a societal perspective, savings totaled approximately $31,500 per person. Because collaborative care both improved outcomes and lowered costs, no ICER was calculated.

When lecanemab was combined with collaborative care, lifetime QALYs increased by 0.42, and years in the community increased by 0.50 compared with usual care. From a healthcare perspective, the combined approach resulted in savings of $8500 per person relative to usual care. From a societal perspective that included additional costs of caregiving, the combined approach cost an additional $3000 per person relative to usual care.

Compared with collaborative care alone, adding lecanemab raised the ICER to $248,000 per QALY from the healthcare perspective and $218,000 per QALY from the societal perspective. 

When scaled to the US population, lecanemab yielded 180,000 QALYs at a cost of $39.5 billion, while collaborative care yielded 1.5 million QALYs and saved $300 billion. 

The results were “robust to uncertainties” in sensitivity analyses, the authors noted. 

Meaningful, Equitable Benefits

“This is the first study to put collaborative dementia care and a disease-modifying therapy for Alzheimer’s on the same metric, allowing an apples-to-apples comparison. We show that each offers different, complementary benefits, and patients and families deserve health systems that offer both high-quality treatment and high-quality care,” said Possin. 

She emphasized that the two interventions address fundamentally different needs and noted that while disease-modifying therapies may slow the underlying biology of AD, they do not resolve symptoms or the daily challenges faced by patients and families, including behavioral changes, mood disturbances, safety concerns, and caregiver stress. 

Possin noted that collaborative dementia care is designed to address those needs by providing ongoing, individualized support, including symptom management, care planning, education, and assistance navigating the health system. Such programs have been shown to improve quality of life for patients and caregivers and reduce healthcare costs, even as the disease progresses.

Atkins said that a key advantage of collaborative care is its broader reach. Current disease-modifying therapies are appropriate only for a subset of patients, typically those diagnosed early and without certain common comorbidities.

Many patients, particularly those in historically underserved communities, are diagnosed later or have medical conditions that make them ineligible for these drugs. In contrast, collaborative care can support patients across the disease course and does not rely on early diagnosis or narrow eligibility criteria. Making it a standard component of the healthcare system could deliver meaningful, more equitable benefits to far more families.

Possin and her colleagues at UCSF Health were instrumental in developing the Care Ecosystem collaborative care model for people with dementia and their families. The program has been adopted and adapted by more than 50 health systems across the US. 

Crystallizing the Value of Collaborative Care

Reached for comment, Robert J. Sawyer, PhD, ABPP, neuropsychologist, co-director, Center for Brain Health at Ochsner Neuroscience Institute, New Orleans, said the study is “important” as it demonstrates that the “economic and quality of life benefit from care management alone far outweighs the economic/quality of life benefit from a very expensive medication.” 

Sawyer, who wasn’t involved in the study, said that “the sheer cost of a collaborative care program is so much less than a drug therapy,” although the two approaches shouldn’t be pitted against each other.

“It doesn’t mean that they’re mutually exclusive. Obviously, both are important, but this study helps to really crystallize in people’s minds the value you get from collaborative care — especially since so many people aren’t eligible for the infusion treatment,” Sawyer said.

He noted that for decades, collaborative dementia care programs were not financially supported by Medicare, forcing health systems to “essentially eat the cost.”

That’s changing. In 2024, the Centers for Medicare & Medicaid Services launched an 8-year pilot program, Guiding an Improved Dementia Experience, which helps cover collaborative dementia care.

The study was funded by the National Institute on Aging. Possin, Atkins, and Sawyer reported no relevant disclosures.