In the second part of our new special newsletter SPOTLIGHT – New Medications for Dementia Jana Rühl, a research associate at digiDEM Bavaria, deals with the publication of the research team led by Professor Sören Mattke from the University of Southern California.
Today's topic is the question of whether healthcare systems can cope with the diagnostic demands arising from the Alzheimer's medications entering care.DOI: 10.14283/jpad.2023.94).
Read Jana Rühl's post now:
New dementia drugs: Is our healthcare system prepared?
The approval of the first monoclonal antibodies, such as Lecanemab and Donanemab, by the American Food and Drug Administration (FDA) has caused a worldwide sensation. However, the joy over this potential breakthrough is marred. Because alongside concerns about the efficacy and safety of the drugs, the question arises with approval: Is our healthcare system organizationally ready for the new medications?
Specialized experts and complex diagnostics necessary
The new Alzheimer's medications, such as Lecanemab or Donanemab, promise to slow the course of the disease in its very early stages. However, not all patients can benefit from them equally. This is because only a very specific group of those affected is eligible for treatment. To reliably identify these patients, complex diagnostics are required, involving multiple brain imaging scans (MRI), blood tests, and the collection of cerebrospinal fluid (CSF). Therefore, early and differentiated diagnostics by specialized physicians are indispensable for identifying suitable patients for therapy in a timely manner. However, the necessary structures and sufficient capacities for this are currently lacking.
Supply bottlenecks and long waiting times
A look at Sweden, a pioneer in dementia care, highlights the urgency of the situation. According to calculations by Prof. Sören Mattke and his colleagues, current diagnostic capacity there is far from sufficient to diagnose eligible patients in time for treatment. Thus, if treatment capacity remains unchanged, the waiting time for those affected in Sweden would rise from 21 months in 2023 to over 50 months in 2028, more than doubling. According to the authors, the primary cause of these long waiting times is the shortage of specialists. To enable a timely diagnosis within six months, approximately 251 additional specialized neurologists, geriatricians, and psychiatrists would need to be available. Over a 20-year period, this would require annual investments of around 81 million euros. Additionally, the increased use of biomarker tests would incur costs of a further 11 million euros.
A similar scenario can be expected for Germany. It is to be assumed that only a fraction of suitable patients would benefit, as the majority of them cannot be diagnosed in time according to the required criteria. The reason for this is the long training periods, the aging of the medical profession, and an emerging shortage of specialists, particularly specialized neurologists, geriatricians, and psychiatrists.
Mattke, S., Gustavsson, A., Jacobs, L., Kern, S., Palmqvist, S., Eriksdotter, M., Skoog, I., Winblad, B., Wimo, A., & Jönsson, L. (2024). Estimates of Current Capacity for Diagnosing Alzheimer’s Disease in Sweden and the Need to Expand Specialist Numbers. The Journal of Prevention of Alzheimer's Disease, 11(1), 155–161.
