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Health care systems in some European countries do not have the capacity to quickly switch from a long-term treatment to a DMARD for the treatment of Alzheimer's disease, which could leave one million people without access to treatment care if such a breakthrough occurs, according to a new RAND Corporation Study.
The researchers looked at the health systems of France, Germany, Italy, Spain, Sweden and the United Kingdom and modeled the problems in the health system. infrastructure starting in 2020 they had to cope with an upsurge in the number of patients seeking screening to determine whether they met the requirements for a treatment allowing Alzheimer's disease development.
The study found that the main problem was the need to have trained medical specialists to diagnose patients likely to present the first signs of Alzheimer's disease and to confirm that they would be eligible for a treatment to prevent progression of the disease to complete dementia.
Some countries have too few medical specialists and may require additional training of health care providers to evaluate early-stage Alzheimer's patients. Another shortcoming is that there are too few facilities capable of providing infusion therapy 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 provide hope that an alternative treatment for the disease could be used routinely within a few years.
"While sustained efforts are being made to develop treatments to slow or block the progression of Alzheimer's dementia, less work has been done to prepare countries' medical systems for such progress," he said. said Jodi Liu, senior author of the study and policy researcher. at RAND, a non-profit research organization based in the United States. "Although there is no certainty that a therapy against Alzheimer's disease will be approved soon, our work suggests that health care officials in the European Union should start thinking about how to react if such a breakthrough occurs. "
The researchers analyzed how a new therapy could challenge the current health system in the six countries examined. The analysis focuses on the supply of dementia specialists, the diagnostic tools used to identify abnormalities of Alzheimer's disease in the brain and access to the infusion centers that would provide the treatment.
The RAND report estimates that nearly one million patients with mild cognitive impairment in six countries could develop Alzheimer's dementia while waiting for evaluation and treatment resources over a two-decade period after the approval of Alzheimer's treatment.
The RAND analysis assumes that a therapy is approved for use beginning in 2020 and that screening should begin in 2019, although the researchers point out that the date was chosen only as a model scenario and not as a predicting when Alzheimer's therapy can be approved.
The study estimates that in such a scenario, about 7.1 million people with mild cognitive impairment would seek a timely diagnosis by a specialist. After follow-up assessments and biomarker testing, the study estimates that in the long run, 2.3 million people in all six countries could be recommended for treatment.
The analysis suggests that health systems in some European countries have insufficient capacity to diagnose and treat the large number of patients with early-stage Alzheimer's disease. The expected waiting times range from five months for treatment in Germany to 19 months for an assessment in France. The first year without waiting time 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 the infusion capacity. In the other four countries, waiting times due to both the availability of specialists and the infusion capacity would delay the treatment of a larger number of patients. Specialist capacity is the main limiting factor in France, the United Kingdom and Spain.
"Each of the countries we have studied is subject to a unique set of medical system constraints and resolving these issues can be difficult," Liu said. "It is therefore important to start now discussions on how to remove these obstacles so that each country is better prepared in case of decisive progress in Alzheimer's disease."
RAND researchers suggest that a combination of reimbursement, regulatory and workforce planning policies will be needed to address the constraints of each medical system. In addition, innovation in the diagnosis and administration of treatment would create sufficient capacity to treat patients with early-stage Alzheimer's disease.
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More information:
The report "Assessment of the state of readiness of the health care system in six European countries for treatment against Alzheimer's disease" is available on www.rand.org
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