Estimating the Future Health and Social Care Costs of Alzheimer's Disease Dementia in the UK: Impact of Disease Modifying Therapy Efficacy, Uptake, and Care Model – A Scenario Modelling Study

TL;DR

This study models how new Alzheimer's treatments could reduce future healthcare costs in the UK by slowing disease progression and changing care models.

Contribution

The study introduces a novel scenario-based model that incorporates DMT efficacy, uptake, and care delivery models to estimate long-term cost impacts of Alzheimer's therapies.

Findings

Alzheimer's dementia cases could decrease by 34,000–98,000 by 2040 with DMTs.

Primary care follow-up models generate larger cost savings (£4.4–12.9 billion) than specialist care.

Cost offsets accelerate about five years after DMT introduction and depend on treatment adoption speed and scale.

Abstract

To model scenarios exploring potential impacts of disease‐modifying therapies (DMTs) for Alzheimer's disease (AD) dementia on future health and social care costs in the United Kingdom.

A cohort Markov model was developed using population projections and published AD epidemiological data. Stage‐specific transition rates (mild cognitive impairment due to AD and mild, moderate, severe AD dementia) and health and social care cost data were applied to estimate cost outcomes over 2020–2040. Potential proportion of eligible population receiving treatment (uptake) and follow‐up care models (primary vs. specialist care) were elicited from expert opinion. Scenarios combined ranges of DMT efficacy estimates, uptake, and care model. DMT price was excluded due to no UK precedent.

Without DMT access, 1,038,405 people (1.5%) were projected to have AD dementia by 2040. Under the various DMT treatment scenarios, the prevalence of AD dementia by 2040 was projected to be 34,000–98,000 cases lower. Associated cumulative cost offsets were higher, £4.4–12.9billion over 2020–2040, in scenarios where most individuals received primary care follow‐up, compared with majority specialist care follow‐up (‐£2.3billion to +£3.2billion). Assuming DMT efficacy of 25%, 58% uptake and majority primary care follow‐up cumulative cost offsets increased from £4.4billion to £10.1billion by 2040 but the UK Health Service would need to diagnose and provide DMT for over a million individuals by 2030 and two million by 2040 to achieve this.

Potential cost offset from DMT are large but highly dependent on the model of healthcare delivery and the ability of healthcare systems to scale up diagnosis and treatment services.

Previous modelling of disease‐modifying therapies (DMTs) in Alzheimer's disease (AD) dementia estimated economic benefits using various estimated DMT efficacies but did not consider how delivery care model and/or uptake might influence long‐term cost savings.Hypothetical DMTs were estimated to yield potentially large reductions in the cost of health and formal social care, leaving aside the cost of the treatments themselves, by reducing the number of people progressing to more severe stages of dementia. Cost offsets begin to accelerate approximately 5 years after DMTs becomes available.The size of these cost offsets depended particularly on the speed and scale of the adoption of DMTs into routine clinical practice and the model for treatment and follow‐up (e.g., having a majority primary‐care model for follow‐up).Early diagnosis and healthcare system preparedness to implement diagnosis, treatment and follow‐up pathways at the necessary scale, will be important factors in the potential for DMTs to reduce the Alzheimer's disease dementia burden on the cost of health and social care.

Previous modelling of disease‐modifying therapies (DMTs) in Alzheimer's disease (AD) dementia estimated economic benefits using various estimated DMT efficacies but did not consider how delivery care model and/or uptake might influence long‐term cost savings.

Hypothetical DMTs were estimated to yield potentially large reductions in the cost of health and formal social care, leaving aside the cost of the treatments themselves, by reducing the number of people progressing to more severe stages of dementia. Cost offsets begin to accelerate approximately 5 years after DMTs becomes available.

The size of these cost offsets depended particularly on the speed and scale of the adoption of DMTs into routine clinical practice and the model for treatment and follow‐up (e.g., having a majority primary‐care model for follow‐up).

Early diagnosis and healthcare system preparedness to implement diagnosis, treatment and follow‐up pathways at the necessary scale, will be important factors in the potential for DMTs to reduce the Alzheimer's disease dementia burden on the cost of health and social care.

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