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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.

Alzheimer's disease is a progressive neurodegenerative disorder that leads to cognitive decline, dementia, and premature death. As the risk of developing Alzheimer's disease increases with age, the burden of Alzheimer's-related dementia will surge in industrialized countries with their graying populations. In the United States, for example, an estimated 5.5 million patients live with Alzheimer's-related dementia today, a number that is projected to increase to 11.6 million by 2040. Results from earlier clinical trials have led to the hypothesis that Alzheimer's dementia must be prevented rather than cured because no therapy has been able so far to reverse manifest dementia. If this new paradigm bears out in late-stage clinical trials, an important health systems challenge will arise, should one or more therapies become available: A substantial number of existing cases with early-stage disease would have to be screened, diagnosed, and then potentially treated as quickly as possible when a therapy first comes to market, in order to prevent progression to full-blown Alzheimer's dementia. This report assesses the preparedness of the U.S. health care system to handle the potential caseload. The authors used published data and expert interviews to develop a simulation model quantifying the match between health system capacity and expected demand. The report presents the results of the model and discusses their implications for patients. As many estimates in the model are subject to substantial uncertainty, the ambition of this report is not to provide an exact prediction of future capacity needs but to illustrate the magnitude of the potential problem.