# Using the generalized risk-adjusted cost-effectiveness (GRACE) model to advance health equity in use of novel treatments for Alzheimer's Disease and Related Dementias

> **NIH NIH R61** · JOHNS HOPKINS UNIVERSITY · 2024 · $322,286

## Abstract

Project Abstract
The newer disease-modifying drugs for Alzheimer’s Disease (AD) target Aβ42 proteins and p-tau
production and accumulation and include antibodies directed at Aβ epitopes. While these drugs offer
hope for individuals affected by AD and related dementias (ADRD) and their families, best practices are
unclear due to potential harms, substantial costs, and modest efficacy. Those affected by ADRD, along
with their families, clinicians, and payers, dynamically make decisions about therapies in response to the
evolving cognitive, physical, behavioral, financial, and emotional challenges as dementia progresses.
Standard cost effectiveness analyses fall short in incorporating the perspectives of the diverse users of
new treatments, who differ in clinical responsiveness, side effects tolerance, risk acceptance, spending
preferences, and use of therapies driven by healthcare access inequities and cultural differences. In the
planning phase (R61), we will conduct focus groups with diverse individuals affected by ADRD to
understand their medication decision-making processes. With this information, we will design discrete
choice experiments to learn how different attributes of a therapy are valued by affected individuals and
what tradeoffs they would make between treatments with different attributes. In the implementation
phase (R33), we will administer the survey, in a web-based format, to a large, nationally representative
sample of older adults conversant in English or Spanish. Experiment results will inform a risk-adjusted
cost-effectiveness (GRACE) model, incorporating relative preferences and health risk attitudes, overall,
and by specific subpopulations of interest, including racial and ethnic subgroups that have experienced
inequities in management of ADRD. Using these estimates, data from the National Health and Aging
Trends Study cohort (2011-2024) with their Medicare claims, and other input data from the literature,
we will develop, validate, and calibrate a health economic evaluation microsimulation model of ADRD
progression and outcomes. We will apply the model to estimate the cost-effectiveness as well as
financial risk and health equity impacts of new existing and hypothetical ADRD drugs, overall and for
specific patient populations disproportionately impacted by ADRD. We will prepare the final models so
that they are accessible for use as additional novel therapies become available.

## Key facts

- **NIH application ID:** 10975994
- **Project number:** 1R61AG088961-01
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Emmanuel Fulgence Drabo
- **Activity code:** R61 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $322,286
- **Award type:** 1
- **Project period:** 2024-08-01 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10975994

## Citation

> US National Institutes of Health, RePORTER application 10975994, Using the generalized risk-adjusted cost-effectiveness (GRACE) model to advance health equity in use of novel treatments for Alzheimer's Disease and Related Dementias (1R61AG088961-01). Retrieved via AI Analytics 2026-05-29 from https://api.ai-analytics.org/grant/nih/10975994. Licensed CC0.

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