People get ready! A new generation of Alzheimer's therapies may require new ways to deliver and pay for healthcare

Abstract

The development of disease‐modifying therapies (DMTs) for Alzheimer's disease (AD) has progressed over the last decade, and the first‐ever therapies with potential to slow the progression of disease are approved in the United States. AD DMTs could provide life‐changing opportunities for people living with this disease, as well as for their caregivers. They could also ease some of the immense societal and economic burden of dementia. However, AD DMTs also come with major challenges due to the large unmet medical need, high prevalence of AD, new costs related to diagnosis, treatment and monitoring, and uncertainty in the therapies’ actual clinical value. This perspective article discusses, from the broad perspective of various health systems and stakeholders, how we can overcome these challenges and improve society's readiness for AD DMTs. We propose that innovative payment models such as performance‐based payments, in combination with learning healthcare systems, could be the way forward to enable timely patient access to treatments, improve accuracy of cost‐effectiveness evaluations and overcome budgetary barriers. Other important considerations include the need for identification of key drivers of patient value, the relevance of different economic perspectives (i.e. healthcare vs. societal) and ethical questions in terms of treatment eligibility criteria.

The efficacy and safety of Chinese herbal medicine for mild cognitive impairment: a systematic review and meta-analysis of randomized placebo-controlled trials

“…Moreover, the high cost and the risk of serious side effects, such as amyloid-related imaging abnormalities with edema or effusions, may limit the broad utilization of this treatment at its current stage ( Alzheimer’s Association, 2023 ; U.S. Food and Drug Administration, 2023 ). The available evidence on the clinical benefits and potential harms of these anti-amyloid treatments for MCI is still limited, indicating the need for more confirmatory trials and post-marketing adverse effect surveillance programs ( Cummings et al, 2023 ; Wahlberg et al, 2023 ; Watt et al, 2023 ; Kaur et al, 2024 ). Researchers suggest that a treatment paradigm characterized by a multifactorial mode of action could offer a more pragmatic approach to address the heterogeneous pathologies observed in MCI ( Kasper et al, 2020 ).…”

Advancements and Challenges in Antiamyloid Therapy for Alzheimer’s Disease: A Comprehensive Review

“…The high cost of lecanemab and the lack of universal insurance coverage pose additional challenges [ 61 ]. Collaborative efforts among stakeholders such as patients, clinicians, insurers, manufacturers, and regulatory agencies are crucial in addressing these obstacles and ensuring access to affordable and effective therapies [ 62 ].…”