Blood‐based biomarkers for Alzheimer's pathology and the diagnostic process for a disease‐modifying treatment: Projecting the impact on the cost and wait times

Abstract

Introduction Concerns have been raised about the limited health system capacity for identification of patients who are eligible for a disease‐modifying Alzheimer's treatment (DMT). Blood‐based biomarker (BBBM) tests are a promising tool to improve triaging at the primary care level. We projected their impact on cost of and wait times during the diagnostic process. Methods We compare four scenarios for triaging patients at the primary care level from the perspective of the U.S. health care system: (1) cognitive test only (Mini Mental State Examination [MMSE]), (2) BBBM test only, (3) MMSE followed by BBBM if positive, and (4) BBBM followed by MMSE if positive. Results Referring patients to dementa specialists based on MMSE or BBBM results alone would continuously require more specialist appointments than projected to be available until 2050. Combining MMSE and BBBM would eliminate wait lists after the first 3 years and reduce average annual cost by $400 to 700 million, while increasing correctly identified cases by about 120,000 per year. Discussion The combination BBBM with MMSE is projected to increase the efficiency and value of the triage process for DMT eligibility.

Projecting the long‐term societal value of a disease‐modifying treatment for Alzheimer's disease in the United States

“…The evolution of patients across stages, in turn, determines our outcomes, like mortality, medical cost, and caregiver burden. Details for these two parts have been previously published 19,20 …”

Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer’s disease (MCI and dementia) in primary care: a review and synthesis

“…For example, recent analyses suggest that triaging patients at the primary care level based on the use of an objective cognition‐screening tool along with in‐development blood‐based biomarkers (BBBMs) represents a potentially efficient and cost‐effective path to accurately identifying incipient AD‐related cognitive decline earlier in the disease course. Such a strategy could eliminate waiting lists for DMT treatment after the first 3 years, whilst increasing correctly identified cases by 120 000 annually [ 13 ]. If the healthcare community is to rise to the challenge, embracing fresh perspectives and new paradigms regarding the diagnosis and treatment of AD, a coordinated effort amongst the multidisciplinary healthcare professional team, policymakers, patient advocates and payers is critical.…”

Projection of budgetary savings to US state Medicaid programs from reduced nursing home use due to an Alzheimer's disease treatment

“…With approximately 21% of Medicaid spending going to long-term care, 33 It should be kept in mind that our projections assume that only a subset of eligible patients will receive treatment because of capacity constraints in diagnosing patients. 18 If all cases could be identified and treated immediately, the cumulative savings would more than quadruple from approximately $186 billion to $989 billion (432%) with $580 and $409 billion accruing to the federal and state component, respectively, of Medicaid. While assuming that all patients would be treated right away is certainly unrealistic, there are several technologies in development that would relieve capacity constraints by improving triage of patients at the primary care level.…”