Sweden Halts Use of New Alzheimer's Drug Over Cost-Effectiveness Concerns Amid Expert Debate

Sweden's NT-rådet, the expert council advising regional healthcare, has decided against adopting the Alzheimer's drug Leqembi (lecanemab) into Swedish healthcare, citing its high cost and questionable cost-effectiveness despite the drug's proven effectiveness in clinical studies. The decision has stirred controversy among Swedish researchers and healthcare experts, highlighting ongoing debates over Alzheimer's treatments' clinical impact and affordability.

Leqembi, developed with key research contributions from Swedish professor Lars Lannfelt, costs an estimated 380,000 kronor per patient annually, translating to an annual expense between 3.7 and 4.2 million kronor for improved health outcomes when scaled. Attempts to negotiate a more affordable price with the manufacturer reportedly failed to meet NT-rådet's cost-effectiveness criteria, leading the council to advise against the drug's use. As a result, Swedish patients will not have access to Leqembi through the public healthcare system, unlike patients in countries such as Germany and Austria, where the drug is available.

The decision has provoked disappointment among experts and patient advocates. Liselotte Jansson, general secretary of the Alzheimer Foundation, expressed regret over the lack of access to a disease-modifying treatment for early Alzheimer's patients in Sweden. Experts like Hugo Lövheim and Henrik Zetterberg emphasized the need for long-term investments in Alzheimer's therapies to address an aging population.

Adding to the complexity, a recent Cochrane report reviewed 17 studies with over 20,000 participants and concluded that the 18-month treatment impact on cognitive functions is minimal or trivial, and potential risks include brain swelling and microscopic bleeding. Francesco Nonino, lead author of that report, stated that the drugs “do not make any meaningful difference for patients.” However, Lannfelt contested the report's conclusions, arguing that 18 months is too short a treatment window to observe significant benefits in a chronic disease potentially lasting 20 years. Linus Jönsson, a health economics professor at the Karolinska Institute, also criticized the report for lumping together data from different Alzheimer's drugs, possibly obscuring individual drug benefits. Jönsson suggested a more reasonable annual price range for treatment would be between 50,000 and 100,000 kronor.

Currently, about 100,000 people in Sweden live with Alzheimer's, but only a small subset with mild symptoms and specific genetic factors qualify for antibody treatments like Leqembi. The NT-rådet’s recommendation will likely be adopted by regional healthcare authorities, pushing some patients to seek high-cost private treatments.

This decision underscores a more extensive debate within Swedish healthcare about balancing clinical efficacy, treatment cost, and patient access as the nation grapples with growing Alzheimer's disease prevalence.