EQUITY IN ACCESS TO ALZHEIMER'S DISEASE PHARMACOLOGIC TREATMENT FOR AFRICAN AMERICAN AND WHITE PATIENTS IN ALABAMA A MIXED METHODS STUDY TO INFORM RECOMMENDATIONS EquAAL

PROJECT SUMMARY New disease modifying drugs, like lecanemab, if used equitably across populations disproportionately affected by

Alzheimer’s disease (AD), like African Americans (AAs), could potentially reduce AD outcome disparities. However, these

drugs are expensive, require costly clinician assessment and brain imaging to determine eligibility, and are administered by intravenous infusion: these features can be challenging for patients of economically disadvantaged states like Alabama. To understand how to deliver new drugs equitably in this state, there is an urgent need to understand: 1)

access to care challenges that contribute to the full cost of new drugs, i.e., cost that includes copayments for drugs, specialist visits and imaging, travel and productivity losses of clinic-based treatment, etc; 2) perceived value of new

drugs, and 3) overall costs and benefits of new drugs, for AA and white AD patients. The objective of this project is to address these knowledge gaps by conducting a mixed methods study and develop an economic analysis for estimating long-term costs and benefits of AD new drugs for AA and white older adults in AL. In a R61 planning phase (Year 1), we

will conduct qualitative analyses to understand challenges of AD patients in 5 domains of access to care: Availability,

e.g., of specialists, infusion clinics, imaging; Accessibility i.e., how easy it is to reach such medical resources; Affordability

of drugs, specialist visits, imaging; Accommodation, i.e., how easy it is to use medical resources; and Acceptability, i.e., perceived benefits and side effects of new drugs, and preferences for treatment attributes including costs. These

analyses will inform framing of the economic analysis, i.e., defining the analysis perspectives and costs and benefits to include under them. We will then develop a Markov model based on published models and set up data collection for its inputs. In the R33 phase (Years 2-5), we will collect model inputs using a survey of 240 patients and/or caregivers

exposed to new (N = 80) and traditional AD drugs, and collecting medical records for 120 patients who had visits with

specialists (neurologists, psychiatrists, or geriatricians). Other inputs will be collected from the literature and public sources. We will obtain base case estimates of costs and benefits for AA and white AL populations, and run extensive

sensitivity analyses to evaluate the robustness of results and the health equity impact of new drugs. This work will occur under the guidance of a Patient&Caregiver and Provider Advisory Board (PPAB) to reflect the voice and relevant contexts of patients, caregivers, and providers in our findings. The PPAB will also help us define hypothetical interventions to

enhance equity in new drug use, for which we will use the economic model to examine their cost-effectiveness. Lastly, we will work with the PPAB to summarize results and develop recommendations for equitable delivery of new drugs in AL to disseminate to academic and non-academic audiences, including provider, patient and caregiver groups, and other

stakeholders. In the supportive environment of the University of Alabama at Birmingham, with the proposed strong community engagement, the investigative team of this project will shed some light on the costs and benefits of new AD drugs for AA and white populations, and inform the equitable distribution of these drugs to positively impact diverse

populations suffering from AD in a disadvantaged US state.