BACKGROUND Immunotherapy for Alzheimer's disease(AD) has gained momentum in recent years. One of the concerns over its application pertains to Cost-Effectiveness Analysis (CEA) from population average and specific subgroup differences, as such a therapy is imperative for health decisionmakers to allocate limited resources. However, this sort of CEA model considering heterogeneous population with risk factors adjustment has been rarely addressed. METHODS We aimed to show the heterogeneity of CEA in immunotherapy for AD in comparison with the comparator without intervention. Economic evaluation was performed via incremental Cost- Effectiveness Ratio (ICER) and Cost-Effectiveness Acceptability Curve (CEAC) in terms of the Quality- Adjusted Life Years (QALY). First, population-average CEA was performed with and without adjustment for age and gender. Secondly, sub-group CEA was performed with the stratification of gender and age based on Markov process. RESULTS Given the threshold of $20,000 of willingness to pay, the results of ICER without and with adjustment for age and gender revealed similar results ($14,691/QALY and $17,604/QALY). The subgroup ICER results by different age groups and gender showed substantial differences. The CEAC showed that the probability of being cost-effective was only 48.8%-53.3% in terms of QALY at population level but varied from 83.5% in women aged 50-64 years, following women aged 65-74 years and decreased to 0.2% in men≥ 75 years. CONCLUSION There were considerable heterogeneities observed in the CEA of vaccination for AD. As with the development of personalized medicine, the CEA results assessed by health decision-maker should not only be considered by population-average level but also specific sub-group levels.

中文翻译：

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轻度和中度阿尔茨海默氏病疫苗接种成本-效果分析中的异质性。

背景技术近年来，针对阿尔茨海默氏病（AD）的免疫疗法获得了发展。关于其应用的关注点之一是来自人群平均水平和特定亚组差异的成本效益分析（CEA），因为这种疗法对于健康决策者必须分配有限的资源。但是，这种考虑到具有风险因素调整的异类种群的CEA模型很少得到解决。方法我们旨在证明CEA在AD免疫治疗中的异质性与没有干预的比较者相比。通过以质量调整生命年（QALY）表示的增量成本效益比（ICER）和成本效益接受曲线（CEAC）进行经济评估。第一，进行了人口平均CEA，且未调整年龄和性别。其次，以马尔可夫过程为基础，按性别和年龄分层进行了CEA分组。结果鉴于支付意愿的门槛为20,000美元，不考虑年龄和性别以及对年龄和性别进行调整的ICER结果显示出类似的结果（14,691美元/ QALY和17,604美元/ QALY）。不同年龄组和性别的ICER亚组结果显示出很大差异。CEAC指出，就人口水平而言，按QALY衡量具有成本效益的可能性仅为48.8％-53.3％，而年龄在65-74岁的女性紧随其后的是50-64岁女性的83.5％，降至0.2％ ≥75岁的男性。结论在针对AD的疫苗的CEA中观察到相当大的异质性。随着个性化医学的发展，