Great expectations: the urgent need for common purpose in Alzheimer’s disease

Managing high expectations

We all want a treatment equivalent to the latest smartphone, with its enormous functionality, but there is a risk that uninformed audiences will instead feel like they are receiving something akin to a more basic mobile phone – a real advance, but less than hoped for.

Communicators will need to manage the often unrealistically high expectations of the media and public, while empowering HCPs and payers with an understanding of a treatment’s role and value. Corporate reputation in the AD community and share price sensitivity are also crucial considerations.

How disease-modifying treatments can be best used also requires education. Unlike many areas where novel therapies are first introduced later within patient pathways, the AD treatments under investigation will need to be given to those with no or very mild symptoms if they are to have benefit.

Health systems will be faced with demands to introduce completely new pathways to diagnose, treat and monitor a potentially large and generally ‘healthy’ patient population.

The cost burden

Payer opinion in AD has shown high levels of concern at the expected cost burden that new treatments and pathways could place on health systems. Budgets have not been routinely set aside for new AD treatments and many payers will be reluctant to establish significant new treatment pathways overnight.

The access landscape is further complicated because many health technology assessment (HTA) methodologies are currently not geared up to evaluate these treatments.

Effective AD treatments will be a cost to health systems but in return will bring relatively little cost benefit to those health systems – by reducing or delaying the level of care people need, they will offer most benefit to social care systems and wider society.

Yet NICE and many other HTA bodies limit their assessment to the cost-effectiveness of treatments to health systems alone, so their methodologies are more likely to report negatively and reduce willingness to pay.