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• If a hypothetical therapy becomes available in 2023, and health system capacity follows historical growth trends, this analysis suggests that Australians could wait over ten months in the initial year to access the therapy.
• The most pressing constraint is the availability of dementia specialists to evaluate and diagnose patients, followed by average waiting times of a few months for biomarker testing to confirm diagnosis and infusion delivery of the treatment.
• The first year without wait times would be 2034. By eliminating wait lists that delay access to the therapy, an estimated 54,000 people would not progress from mild cognitive impairment due to AD to Alzheimer's dementia between 2023 and 2033.

Disease-modifying therapies to prevent or delay the progression of Alzheimer's disease (AD) are under clinical investigation. AD is the leading cause of dementia, and the more than 800,000 Australians with mild cognitive impairment in 2018 could potentially benefit from a therapy that reduces the risk of progression to dementia.

This report assesses the magnitude of the potential health system challenges in the diagnosis and treatment of early-stage Alzheimer's disease in Australia, given the hypothetical availability of a disease-modifying therapy. The authors use a simulation model to compare the expected number of patients with the capacity of the health system and assess three possible constraints: visits to dementia specialists, biomarker testing, and infusion delivery. They find that the most pressing constraint is the availability of dementia specialists to evaluate and diagnose patients, followed by average waiting times of a few months for biomarker testing to confirm diagnosis and infusion delivery of the treatment. By eliminating wait lists that delay people from accessing the therapy, they estimate that 54,000 Australians would not progress from mild cognitive impairment due to AD to Alzheimer's dementia between 2023 and 2033.

Although the analysis includes simplifying assumptions and is not predictive of the future, the intention is to facilitate discussions among stakeholders. Multiple stakeholders would need to coordinate reimbursement, workforce and capacity planning, and outreach efforts to ensure that people with early-stage AD would have timely access if a therapy becomes available.

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