EU countries unprepared to move future Alzheimer's treatment into rapid clinical use

October 1, 2018, RAND Corporation

The health care systems in some European countries lack the capacity to rapidly move a disease-modifying treatment for Alzheimer's disease from approval into widespread clinical use, which could leave 1 million people without access to transformative care if such a breakthrough occurs, according to a new RAND Corporation study.

Researchers examined the health systems of France, Germany, Italy, Spain, Sweden and the United Kingdom and modeled the infrastructure challenges beginning in 2020 if confronted with a surge of seeking screening to determine if they qualify for a treatment that might prevent or delay the development of Alzheimer's.

The study found the primary problem is the need for medical specialists trained to diagnose patients who may have early signs of Alzheimer's and confirm that they would be eligible for therapy to prevent the progression of the disease to full-blown dementia.

Some nations have too few medical specialists and may require additional training of health providers to evaluate early-stage Alzheimer's patients. Another shortcoming is that there are too few facilities with capacity to deliver infusion treatments to patients.

The burden of Alzheimer's disease in high-income countries is expected to nearly double between 2015 and 2050. Recent positive results from clinical trials give hope that a disease-changing treatment could become available for routine use within a few years.

"Although there is continued effort to develop treatments to slow or block the progression of Alzheimer's dementia, less work has been done to prepare nations' medical systems to deliver such an advancement," said Jodi Liu, senior author of the study and a policy researcher at RAND, a U.S.-based nonprofit research organization. "While there is no certainty an Alzheimer's therapy will be approved soon, our work suggests that health care leaders in the European Union should begin thinking about how to respond should such a breakthrough occur."

Researchers analyzed how a new therapy might challenge the current health care system in the six nations examined. The analysis focuses on the supply of dementia specialists, diagnostic tools used to identify Alzheimer's abnormalities in the brain, and access to infusion centers that would deliver the treatment.

The RAND report estimates that as many as 1 million patients with mild cognitive impairment from the six countries could develop Alzheimer's dementia while waiting for evaluation and treatment resources over a two-decade period after approval of an Alzheimer's therapy.

The RAND analysis assumes that a therapy is approved for use beginning in 2020 and screening would begin in 2019, although researchers stress that the date was chosen only as a scenario for the model, not as a prediction of when an Alzheimer's therapy may be approved.

The study estimates that under such a scenario about 7.1 million people with would seek timely diagnosis by a specialist. After follow-up evaluations and biomarker testing, the study estimates that 2.3 million people in the six countries ultimately may be recommended for treatment.

The analysis suggests that the systems in some of the European countries have insufficient capacity to diagnose and treat the large number of patients with early-stage Alzheimer's disease. The projected peak range from five months for treatment in Germany to 19 months for evaluation in France. The first year without wait times would be 2030 in Germany, 2033 in France, 2036 in Sweden, 2040 in Italy, 2042 in the United Kingdom and 2044 in Spain.

In Germany and Sweden, the main infrastructure constraint would be infusion capacity. In the other four countries, wait times caused by both specialist availability and infusion capacity would delay treatment for more significant numbers of patients. Specialist capacity is the primary rate-limiting factor in France, the United Kingdom, and Spain.

"Each of the countries we studied has a unique set of medical system constraints and addressing those issues may turn out to be challenging," Liu said. "So it is important to begin discussions now about how to address these obstacles so that each nation is best prepared if a Alzheimer's breakthrough occurs."

RAND researchers suggest that a combination of reimbursement, regulatory, and workforce planning policies will be needed to address constraints in each medical system. In addition, innovation in diagnosis and delivery would help ensure that sufficient capacity is created to treat patients with early-stage Alzheimer's disease.

Explore further: An Alzheimer's treatment would tax the US health care system

More information: The report, "Assessing the Preparedness of the Health Care System Infrastructure in Six European Countries for an Alzheimer's Treatment," is available at www.rand.org

Related Stories

An Alzheimer's treatment would tax the US health care system

November 15, 2017
The U.S. health care system lacks the capacity to rapidly move a treatment for Alzheimer's disease from approval into wide clinical use, a shortcoming that could leave millions of people without access to transformative care ...

Challenge continues in developing effective drug treatment for Alzheimer's disease

September 24, 2018
The results of a large-scale international study involving the treatment of Alzheimer's disease, which was led and coordinated by researchers at Trinity College Dublin, have just been published this week in a major medical ...

Population of Americans with Alzheimer's will more than double by 2060, study shows

December 7, 2017
About 15 million Americans will have either Alzheimer's dementia or mild cognitive impairment by 2060, up from approximately 6.08 million this year, according to a new study by researchers at the UCLA Fielding School of Public ...

Study predicts most people with earliest Alzheimer's signs won't develop dementia associated with the disease

May 22, 2018
During the past decade, researchers have identified new ways to detect the earliest biological signs of Alzheimer's disease. These early signs, which are detected by biomarkers, may be present before a person starts to exhibit ...

New forecast shows 6 million with Alzheimer's disease, cognitive impairment

December 8, 2017
Using new methodology, scientists calculate that approximately 6 million American adults have Alzheimer's disease or mild cognitive impairment, which can sometimes be a precursor to the disease. The estimate, funded by the ...

UK, US drugmakers scrap 'futile' Alzheimer's treatment trial

June 12, 2018
British and American pharmaceutical giants AstraZeneca and Eli Lilly on Tuesday said they were ending a large clinical trial of a treatment for Alzheimer's that they had been developing jointly.

Recommended for you

Neurons with good housekeeping are protected from Alzheimer's

December 17, 2018
Some neurons in the brain protect themselves from Alzheimer's with a cellular cleaning system that sweeps away toxic proteins associated with the disease, according to a new study from Columbia University and the University ...

Growing a brain: Two-step control mechanism identified in mouse stem cells

December 17, 2018
Scientists have identified two distinct control mechanisms in the developmental transition of undifferentiated stem cells into healthy brain cells. This fundamental research using mice may inform regenerative medicine treatments ...

Does diabetes damage brain health?

December 14, 2018
(HealthDay)—Diabetes has been tied to a number of complications such as kidney disease, but new research has found that older people with type 2 diabetes can also have more difficulties with thinking and memory.

Amyloid pathology transmission in lab mice and historic medical treatments

December 13, 2018
A UCL-led study has confirmed that some vials of a hormone used in discontinued medical treatments contained seeds of a protein implicated in Alzheimer's disease, and are able to seed amyloid pathology in mice.

Study links slowed brainwaves to early signs of dementia

December 13, 2018
To turn back the clock on Alzheimer's disease, many researchers are seeking ways to effectively diagnose the neurodegenerative disorder earlier.

New discoveries predict ability to forecast dementia from single molecule

December 11, 2018
Scientists who recently identified the molecular start of Alzheimer's disease have used that finding to determine that it should be possible to forecast which type of dementia will develop over time—a form of personalized ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.