Current Capacity for Diagnosing Alzheimer’s Disease in Germany and Implications for Wait Times

Article type: Research Article

Authors: Mattke, Soeren^{a; *} | Tang, Yu^a | Hanson, Mark^a | von Arnim, Christine A.F.^b | Frölich, Lutz^c | Grimmer, Timo^d | Onur, Oezguer A.^e | Perneczky, Robert^{f; g; h; i; j} | Teipel, Stefan^{k; l} | Thyrian, Jochen René^{k; m; n}

Affiliations: [a] The USC Brain Health Observatory, USC Dornsife, Los Angeles, CA, USA | [b] Department of Geriatrics, University Medical Center Goettingen, Goettingen, Germany | [c] Department of Geriatric Psychiatry, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany | [d] Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Munich, Germany | [e] Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany | [f] Department of Psychiatry and Psychotherapy, LMU Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany | [g] German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany | [h] Munich Cluster for Systems Neurology (SyNergy), Munich, Germany | [i] Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK | [j] School of Public Health, Imperial College London, London, UK | [k] Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Rostock, Rostock, Germany | [l] Department of Psychosomatic Medicine, University Medicine Rostock, Rostock, Germany | [m] Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany | [n] Faculty V, University of Siegen, Siegen, Germany

Correspondence: [*] Correspondence to: Soeren Mattke, MD, DSc, Director, The USC Brain Health Observatory, Research Professor of Economics, USC Dornsife, 635 Downey Way, #505N, Los Angeles, CA 90089, USA. E-mail: mattke@usc.edu.

Abstract: Background:Amyloid-targeting therapies for Alzheimer’s disease (AD) might become available in Germany soon. The combination of a large pool of prevalent cases and a complex diagnostic process to determine eligibility for these treatments is likely to challenge health systems’ capacity. Objective:To analyze Germany’s healthcare system capacity to identify treatment-eligible patients in a timely and equitable manner. Methods:We modeled patients’ diagnostic journey and projects wait times due to capacity constraints for AD specialist visits and PET scans from 2024 to 2043. Model parameters were derived from published data and expert input. Results:Wait times would be ∼50 months over the model horizon, if patients were referred to specialists based on a brief cognitive assessment in primary care. Wait times for patients with social health insurance are projected to be 1.9 times those of patients with private insurance, with peak wait times of around 76 and 40 months, respectively. Adding a blood test for the AD pathology as additional triage step would reduce wait times to below 24 months. Conclusions:In spite of having a well-resourced health system, Germany is projected to be unable to cope with the demand for biomarker-based AD diagnosis, if a disease-modifying AD treatment were introduced. As these treatments might become available by the end of 2024, decisive action, in particular dissemination of high-performing AD blood tests for triage in primary care, will be needed to prevent delays in access and potentially avoidable and inequitable disease progression.

Keywords: Alzheimer’s disease, biomarker, disease-modifying treatment, health system preparedness, specialty care, diagnosis, wait times

DOI: 10.3233/JAD-240728

Journal: Journal of Alzheimer's Disease, vol. 101, no. 4, pp. 1249-1259, 2024