How well is China’s healthcare system prepared to provide access to a disease‐modifying Alzheimer’s treatment?

Abstract

AbstractBackgroundWhile the majority of patients with Alzheimer’s disease (AD) reside in low and middle‐income countries, little is known of their preparedness for disease‐modifying treatments. We project wait times for access to treatment in China, the world’s most populous and still a middle‐income country.MethodMarkov model to estimate wait times based on population, prevalence and capacity data for 2024 to 2044, by desk research and interviews with 45 experts. Base case assumes that 20% of individuals aged 50 and older with no prior evaluation for cognitive impairment would visit a hospital‐based specialist clinic for evaluation and biomarker testing, and if positive, to confirm presence of amyloid and determine treatment eligibility would be determined with PET scanning (37%) or CSF analysis (63%). In two alternative scenarios, individuals would first see a primary care clinician and be referred to a clinic if (1) a brief test suggested mild cognitive impairment, or if (2) in addition a blood test with sensitivity of 0.89 and specificity of 0.73 suggested presence of AD pathology.ResultUnder current practice in China, where gatekeeping by primary care is uncommon and referrals to AD specialty care not required, specialist capacity would be overwhelmed, resulting in lengthy wait‐times throughout the simulation. (Figure 1). Using a model of specialist referral based on cognitive testing in primary care, wait times would peak at 90 months in 2028 and later remain at 50‐60 months. Confirmatory biomarker testing in specialist clinics would become the rate‐limiting constraint. (Figure 2) Adding an AD blood test would lower peak wait times to 55 months and to about two years later (Figure 3).ConclusionWe project extremely long wait times in China to gain access to AD treatment under current practice. Triage in primary care, including a blood test before PET/CSF testing would reduce wait times, albeit only to about two years. With dementia specialists per capita comparable to Japan and growing, the main constraint is capacity for confirmatory biomarker testing. Higher performing blood tests, greater reliance on CSF and expanding PET capacity would rein in wait times, provided that growth in specialist capacity is maintained.