Jan 30, 2024
The authors modeled how patient uptake and health care system capacity will affect the delivery of Alzheimer’s disease–modifying therapies. They expand on prior work by examining the role of primary care and U.S. geographic variation in capacity.
Widespread availability of effective disease-modifying therapies (DMTs) would be a breakthrough in slowing the progression of early-stage Alzheimer’s disease (AD) to later stages of dementia. An AD DMT has received traditional approval from the Food and Drug Administration, and more candidates are on the horizon. The authors used a simulation model to assess patient demand and provider supply for the delivery of AD DMTs. They expanded on prior modeling by including the capacity of primary care practitioners (PCPs) who perform brief cognitive assessments and by utilizing county-level data.
The results suggest that engaging the primary care workforce in the diagnostic process would be vital to accelerate the delivery of AD DMTs, which will overwhelm neurology and geriatric practices that often already have wait lists for appointments. Under the base case assumptions, the states with the longest wait times are Alaska, Arkansas, Idaho, Mississippi, Montana, Nevada, Oklahoma, and Wyoming. Primary care models and telehealth models could help improve access to care in these areas. Further work is needed to evaluate how primary care–led models of care can widely and effectively evaluate and manage treatment for people with early-stage AD, as well as how technological advancements, such as improved biomarkers and computerized testing, can be integrated into workflows.