Preparedness of the Brazilian health‐care system to provide access to a disease‐modifying Alzheimer's disease treatment

Abstract

Background: While the majority of patients with Alzheimer's disease resides in low and middle-income countries, little is known of their preparedness for emerging disease-modifying treatments. We analyze the preparedness of Brazil, one of the most populous middle-income countries, from a capacity and institutional preparedness perspective.Methods: Desk research and 12 interviews for background and capacity data. Markov model to estimate wait times for access to treatment.Findings: Brazil has no national dementia strategy or established pathway for evaluation of cognitive concerns, and dementia is typically diagnosed late if at all. While members of private health plans have ready access to elective specialty care, wait times in the public sector are long. Assuming potentially treatment-eligible patients are referred from primary to specialty care based on a brief cognitive exam and a blood test for the Alzheimer's pathology, available capacity will not be sufficient to match the projected demand. The biggest obstacle is availability of dementia specialist visits, and the effect of population growth and ageing means that the wait list for specialist appointment will continue to grow from around 400,000 in 2022 to over 2.2 million in 2040. We do not project substantial wait times for confirmatory biomarker testing and treatment delivery but note that this is a consequence of patients waiting for their specialist appointments. These queues will result in estimated persistent wait times for treatment of around two years on average with substantial differences between the public and private sectors, as capacity growth is insufficient to keep up with increasing demand.Discussion: Our findings suggest that Brazil is ill-prepared to provide timely access to an Alzheimer's treatment with predicted wait times of about two years, largely because of a limited number of dementia specialists.

Preparedness of China's health care system to provide access to a disease‐modifying Alzheimer's treatment

“…Our findings suggest that China's health care system is ill prepared to provide timely access to an Alzheimer's treatment, with predicted wait times of about 2 years and a growing number of people on wait lists, even in our third scenario with triage steps including a brief cognitive assessment and a blood test for AD pathology. To our knowledge, this is only the second such study conducted in a middle‐income country after Brazil, 8 whereas several have been published on high‐income nations. The overall results resemble what has been found in those earlier studies.…”

“…For example, an analysis of the U.S. health care system 36 predicted wait times of over 50 months based on established diagnostic technology and about 1 year with use of a blood test for AD pathology. The aforementioned study of Brazil predicted average wait times of over 2 years, even with the use of a blood test 8 …”

“…The aforementioned study of Brazil predicted average wait times of over 2 years, even with the use of a blood test. 8 However, the causes for extended wait times were found to be different in China. Although those 8,36 and other studies 5 had found the scarcity of AD specialists to be the main constraint, China has-in theory-sufficient specialist capacity, with about as many AD specialists per capita as Japan, a G7 country with about three times the share of population, who are 65 years of age and older (30% vs 13%).…”

“…8 However, the causes for extended wait times were found to be different in China. Although those 8,36 and other studies 5 had found the scarcity of AD specialists to be the main constraint, China has-in theory-sufficient specialist capacity, with about as many AD specialists per capita as Japan, a G7 country with about three times the share of population, who are 65 years of age and older (30% vs 13%). 37 In practice, this capacity would still be overwhelmed by the expected influx of patients, because of the unusual situation of patients going directly to specialty care without referral or triage.…”

“…Studies in other high‐income countries have found similar problems 4–6 . However, the majority of patients with AD reside in low‐ and middle‐income countries, 7 of which Brazil is the only country that been studied for its capacity to deliver such a treatment and the implications for access to future disease‐modifying therapies 8 . The study estimated wait times of over 2 years, albeit with the assumption that a blood test for the AD pathology would be widely available.…”