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Addressing Alzheimer's Disease in Patients

• Alzheimer's disease is a progressive neurodegenerative disorder that leads to cognitive decline, dementia, and premature death. No disease-modifying treatment is available today but encouraging results from clinical trials offer hope that one or more therapies will become available as early as 2020.
• This prospect raises the question of how well the U.S. health care system is prepared to handle the expected large number of patients. Almost 15 million people with Mild Cognitive Impairment, a condition that may signal early-stage Alzheimer's disease, are projected to live in the U.S. by 2019. They will have to be evaluated by specialists, undergo diagnostic testing for the disease and be treated.

Modeling a Future Caseload

• A simulation analysis shows that projected capacity is insufficient to handle the expected case load and predicts that patients would have to wait an average of 18.6 months for treatment in 2020. Approximately 2.1 million patients would develop Alzheimer's dementia between 2020 and 2040 while on waiting lists.
• The most pressing constraint is limited capacity of dementia specialists to evaluate and diagnose patients, but access to imaging to confirm Alzheimer's disease and to infusion centers to deliver the treatment would also contribute to waiting times.
• Addressing the capacity constraints may turn out to be as challenging as developing an effective treatment, as it requires solving a complex puzzle consisting of payment policy, regulatory requirements, workforce considerations, and capacity planning at the national and local levels, combined with awareness campaigns.
• No individual stakeholder will be able to put all the pieces together alone. This report intends to inform a discussion among stakeholders and create a sense of urgency to start collaborating on addressing the obstacles in a timely manner.