By Jeff Kelley 

As the federal government prepares to negotiate Medicare prescription drug prices for the first time, a Virginia Commonwealth University researcher is leading an effort to determine whether current methods for judging the “value” of new Alzheimer’s treatments are accurate – and whether they disadvantage vulnerable older adults. 

Adam Atherly, Ph.D., a professor in the Department of Health Administration in VCU’s College of Health Professions, recently advanced to the second phase of a five-year, $2.34 million National Institutes of Health grant designed to develop more equitable ways to assess the cost-effectiveness of new Alzheimer’s drugs. In particular, he is looking to identify value that goes beyond common economics, in areas such as caregiver burden and patients’ resilience. 

The work responds to a 2020 NIH call for research on how emerging Alzheimer’s treatments affect health equity. Atherly said his team proposed a deeper look at cost-effectiveness measures, which guide policy decisions about which medications are worth public investment. 

“These measures sound objective, but they’re built on assumptions that can unintentionally favor some patient groups over others,” he said.  

Under the 2022 Inflation Reduction Act, the federal government gained authority to negotiate drug prices for the first time. Accurate pricing depends on understanding a drug’s true value, and Atherly said current formulas are limited in scope and often biased against treatments for older or vulnerable patients. His research aims to build improved models that more accurately reflect value across different patient subgroups. 

Atherly’s team spent the first two years of the grant reassessing clinical trial data for new Alzheimer’s drugs and conducting interviews with patients and caregivers in historically under-resourced Richmond communities. That input helped identify aspects of value – such as caregiver burden, household cost and the toll on older spousal caregivers – that traditional cost-effectiveness models typically ignore.  

“If we’re going to evaluate Alzheimer’s drugs in a way that reflects the realities families face, we need broader measures that account for the full societal impact,” Atherly said.  

A key component of the project is the qualitative research led by VCU’s Department of Gerontology, which is examining the lived experiences of older adults and caregivers who are navigating dementia and Alzheimer’s disease. The research team’s work captures areas that traditional economic formulas rarely reflect – such as hope, uncertainty, resilience, caregiver strain and the social and emotional consequences of the disease.  

Those insights help ensure that Atherly’s cost models account for factors that matter deeply to families but remain invisible in numerical datasets, said VCU gerontology professor Faika Zanjani, Ph.D., associate dean for research in the College of Health Professions.  

“By integrating these perspectives, our work creates a more holistic evidence base, ensuring that economic models are informed not only by clinical outcomes but also by the values and priorities that matter most to individuals and families,” she said. “The ultimate goal of this work is to broaden the definition of value in health care and ensure that all dementia and Alzheimer’s disease patient and caregiver voices are meaningfully incorporated into care decisions, whether those decisions are made in a clinic, in the C-suite or at the policy level.” 

The Department of Gerontology’s involvement also helps the project address the complexities of aging more fully, including multimorbidity, long-term caregiving and the intergenerational consequences that Alzheimer’s disease imposes on families. By grounding research in the voices of diverse older adults and particularly those in historically under-resourced communities, the team hopes to shape a deeper understanding of value that reflects how interventions are experienced in real life.  

“Gerontology’s contributions strengthen the project’s goal of designing more equitable, realistic frameworks for evaluating new Alzheimer’s treatments,” Atherly said. 

Alzheimer’s disease, he noted, is both a national research priority and a personal issue for many families. As the population ages, the costs of care are expected to surge, even as new treatments raise difficult questions about affordability and benefit. 

“Our goal is to give policymakers better tools,” Atherly said. “If the U.S. is moving toward drug price negotiation, we need methods that are rigorous, transparent and fair to the full diversity of the American population.” 

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A version of this story was originally published by VCU College of Health Professions.