Quebec and Netherlands Reject Public Coverage of Alzheimer's Drug Lecanemab Despite Health Canada Approval
Key Insights
Quebec's health advisory committee INESSS (search) rejected public funding for lecanemab, concluding the drug's cognitive benefits are too modest to be clinically significant and provide no demonstrated improvement in quality of life.
The Netherlands' National Healthcare Institute similarly recommended against insurance coverage, stating that patients "do not notice a sufficient difference after treatment" and still "deteriorate significantly" while facing serious side effects.
Both decisions highlight growing scrutiny over lecanemab's clinical value despite regulatory approvals, with the drug carrying a $32,000 annual price tag in Canada and risks including brain hemorrhages and swelling.
Quebec will not publicly fund lecanemab, the first Health Canada-approved treatment targeting the underlying cause of Alzheimer's disease (search), after an expert committee concluded its benefits are too modest to improve patients' lives. The decision by Quebec's National Institute for Excellence in Health and Social Services (INESSS (search)) marks the first time a Canadian government advisory body has evaluated the medication for public coverage.
The Netherlands has reached a similar conclusion, with its National Healthcare Institute (Zorginstituut (search)) recommending against basic health insurance coverage for the drug, marketed as Leqembi.
Limited Clinical Benefits Drive Rejection
INESSS (search) experts rejected lecanemab without considering its price, determining the drug failed to provide clear therapeutic value. According to the committee's notice to Quebec's health minister, "The gains observed with lecanemab on cognitive and functional decline (e.g., memory, self-care, judgment) in a clinical trial are limited and below what is generally considered clinically significant. Furthermore, there is no demonstrated improvement in quality of life."
The Dutch healthcare institute echoed these concerns, stating that lecanemab's effect is so minimal that patients "do not notice a sufficient difference after treatment" and still "deteriorate significantly." Neurologist Edo Richard of Radboud University Medical Center emphasized that "patients find it especially important to remain as independent as possible from help from others. But treatment with lecanemab does not change anything noticeable in daily life."
Safety Concerns Compound Efficacy Questions
Both advisory bodies highlighted serious safety risks associated with lecanemab treatment. The drug puts patients at risk of brain hemorrhages and brain swelling, which can lead to paralysis, loss of speech, severe confusion, and in rare cases, death, according to the Dutch healthcare institute.
Health Canada approved lecanemab in October for patients with mild cognitive impairment or early Alzheimer's disease (search) who have confirmed amyloid (search) buildup in the brain and do not carry two copies of a gene that raises the risk of serious side effects, including brain swelling and bleeding.
Drug Mechanism and Modest Efficacy
Lecanemab works by binding to amyloid (search) proteins in the brain, causing the body to eliminate these deposits linked to Alzheimer's disease (search). The drug does not cure or halt cognitive decline but slows disease progression by 27 percent on average, allowing some patients to remain in the mild stage longer, according to the main clinical trial that led to regulatory approval.
Cost and Access Implications
The medication carries a substantial financial burden, with Eisai Co. Ltd. (search) setting the annual price at approximately $32,000 in Canada. Additional costs include required PET scans or spinal fluid tests to confirm amyloid (search) presence, genetic testing, and frequent MRIs in the first year to monitor for brain swelling and microbleeds.
Laveena Kamboj, senior director of value access and policy at Eisai Canada, expressed disappointment with the INESSS (search) decision, noting that "INESSS reached a fundamentally different conclusion on Leqembi's benefit-risk profile when compared to Health Canada," which spent two and a half years reviewing the drug.
Geographic Variations in Coverage Decisions
Despite Quebec's rejection, lecanemab may still receive public funding elsewhere in Canada. The Canada's Drug Agency, which advises provinces outside Quebec, is scheduled to release a draft recommendation in February.
The drug will remain available in Canada starting next month for patients with private insurance coverage or those able to pay out of pocket, according to Eisai Canada.
Expert Perspectives on Treatment Access
Howard Chertkow, a neurologist and senior scientist at the Baycrest Academy for Research and Education in Toronto, expressed concern that INESSS (search) is "using a bit of a sledgehammer" with its blanket rejection. He noted that Alzheimer's is a heterogeneous disease, meaning some patients will respond well to lecanemab while others won't see positive effects. Under the current decision, only wealthy Quebec patients will be able to access the treatment.
Zorginstituut (search) director Mark Janssen acknowledged the broader implications, calling it "a great disappointment that lecanemab is not a breakthrough. Hopefully, that breakthrough will come in the coming years."