Lecanemab (Leqembi), the Eisai antibody treatment for early Alzheimer's disease, should not be considered for reimbursement in Ireland, the National Centre for Pharmacoeconomics (NCPE) has recommended. Its assessment, completed on 13 October 2026, found the medicine is not cost-effective "at any price to wholesaler". The final funding decision rests with the HSE.
The NCPE published its recommendation, a technical summary and a plain English summary on its lecanemab assessment page (HTA ID 24052). The finding was reported by the Irish Medical Times on 17 October 2026. The applicant, Eisai Limited, is seeking hospital pricing approval for the drug.
- Recommendation: the NCPE recommends that lecanemab "not be considered for reimbursement".
- Price: cost-effectiveness could not be reached even with a 100% discount on the price to wholesaler.
- Cost per QALY: EUR 139,566 in the company's base case and EUR 231,128 in the NCPE's exploratory base case.
- Population: adults with early Alzheimer's disease who carry no copy or one copy of the APOE e4 gene variant, with confirmed amyloid pathology.
- Budget: a five-year net drug budget impact of EUR 18.6 million, including VAT, under the company's capacity assumptions.
- Next step: the HSE makes the final reimbursement decision.
What the NCPE assessed
The NCPE carried out a full health technology assessment (HTA), the more detailed of its two review routes. A rapid review completed on 28 January 2025 recommended a full HTA, which the HSE commissioned on 29 May 2025. Eisai Limited sent its full submission on 13 January 2026. The assessment was paused at the company's request on 11 May 2026 and restarted several times before it was completed on 13 October 2026.
The indication matches the EU licence. The European Medicines Agency lists an EU marketing authorisation from 15 April 2025 for adults with mild cognitive impairment or mild dementia due to Alzheimer's disease who are APOE e4 non-carriers or heterozygotes with confirmed amyloid pathology. The licence includes a controlled access programme to keep use within that group. Recent EU decisions are tracked on our EMA approvals tracker.
Lecanemab is given by intravenous infusion of 10 mg/kg every 14 days and is stopped when a patient progresses to moderate Alzheimer's disease.
Why the NCPE said no
The clinical evidence came from the phase III Clarity AD trial. Results for the EU-licensed group came from a post-hoc analysis of APOE e4 non-carriers and heterozygotes, about 85% of trial participants, which the NCPE said "introduces a risk of bias and uncertainty". At 18 months the difference in the CDR-SB score, a combined measure of cognition and daily function, was -0.58 points in favour of lecanemab compared with placebo. The plain English summary says lecanemab "has only a small effect on slowing the loss of cognition".
The NCPE also found problems with the company's economic model. Its predictions of how many patients would be in each disease stage differed substantially from what was seen in the trial, and "the magnitude of these differences cast doubt upon the suitability of the submitted CEM for decision-making." For that reason, the NCPE treats its own adjusted analysis as exploratory only.
Under both the company and NCPE analyses, the probability that lecanemab is cost-effective at the thresholds of EUR 20,000 and EUR 45,000 per quality-adjusted life year (QALY) was 0%. The technical summary concludes: "Lecanemab is not cost effective, for this indication at any price to wholesaler."
The figures in the assessment
| Measure | Figure |
|---|---|
| Company base case ICER | EUR 139,566 per QALY |
| NCPE exploratory ICER | EUR 231,128 per QALY |
| Price to wholesaler | EUR 310 (200 mg vial), EUR 615 (500 mg vial) |
| Drug cost per patient per year | EUR 25,764 to EUR 27,511, including VAT |
| Eligible patients | 2,905 in year one, rising to 3,353 in year five |
| Patients treated (capacity-limited) | 29 in year one, rising to 109 in year five |
| Five-year net drug budget impact | EUR 18.6 million (EUR 41.0 million in a higher-capacity scenario) |
The drug cost figures exclude infusions, MRI scans and genetic testing. The Irish Medical Times reported that, including administration and monitoring, treatment could cost up to EUR 60,000 per patient per year. The NCPE noted that the company's budget analysis did not include these wider healthcare costs.
Side effects and monitoring
Amyloid-related imaging abnormalities (ARIA) were more common with lecanemab. In the EU-licensed group, ARIA-E (brain swelling or fluid) occurred in 8.9% of people on lecanemab and 1.3% on placebo, and symptomatic ARIA-E in 1.6% and none. Infusion-related reactions affected 25.8% and 7.1%. The licence requires MRI scans at baseline and before the third, fifth, seventh and fourteenth doses, which the NCPE said would need both planned and responsive MRI access.
Reaction from the Alzheimer Society of Ireland
The Alzheimer Society of Ireland made a patient organisation submission, which the HSE will consider. Dr Diane O'Doherty, the society's interim research and policy manager, told the Irish Medical Times: "We know that this news will be disappointing for families affected by dementia." She described the recommendation as "one step in the reimbursement process" and said access "should be determined by clinical eligibility and informed choice". The society suggested a controlled managed access programme at selected specialist sites and noted that lecanemab is available privately in Ireland. No response from Eisai or the HSE beyond the process statement was found when this article was prepared.
How Ireland compares
The NCPE noted that seven of the eight national HTA bodies that have assessed lecanemab for this indication have recommended against reimbursement. It did not name them. In England, NICE's final draft guidance in June 2025 did not recommend lecanemab for routine NHS use or managed access. After an appeal hearing on 13 January 2026, the appraisal was sent back to the committee for reconsideration, Alzheimer Europe reported.
For a similar HSE process, see our report on what the NCPE numbers show for Mounjaro. Readers can also follow studies recruiting in Ireland on our clinical trials tracker.
Frequently Asked Questions (FAQ)
Q: Has the HSE refused to fund lecanemab?
A: Not yet. The NCPE advises the HSE, which makes the final decision after considering the assessment, the patient organisation submission and the criteria in the Health (Pricing and Supply of Medical Goods) Act 2013.
Q: Who is lecanemab licensed for in the EU?
A: Adults with mild cognitive impairment or mild dementia due to Alzheimer's disease who carry no copy or one copy of APOE e4 and have confirmed amyloid pathology.
Q: Would a lower price change the outcome?
A: Under the NCPE's exploratory analysis, no. Cost-effectiveness was not reached even with a 100% discount on the price to wholesaler.
Q: What should patients do?
A: Treatment decisions are for clinicians, and public funding decisions are for the HSE. This article does not give medical advice.
Conclusion and Outlook
The NCPE's finding is firm: it found lecanemab not cost-effective at any price under its analysis, and it doubted the company's model. The HSE now has to weigh that against the Alzheimer Society of Ireland's submission and the other statutory criteria. The HSE has not said when it will decide.
Cover image: AI-generated illustration of an older person's hands and a clinician in a memory clinic setting. It does not show any real person, product or facility.
Sources
- National Centre for Pharmacoeconomics, Lecanemab (Leqembi) HTA ID 24052, assessment completed 13 October 2026
- National Centre for Pharmacoeconomics, NCPE Assessment Summary, 13 October 2026
- National Centre for Pharmacoeconomics, Plain English Summary, October 2026
- European Medicines Agency, Leqembi EPAR
- Irish Medical Times, Groundbreaking Alzheimer's drug not cost-effective "at any price": NCPE, 17 October 2026
- Alzheimer Europe, NICE to reconsider lecanemab and donanemab following successful appeals, 20 March 2026
