Hlavka Jakub P, Mattke Soeren, Liu Jodi L
Rand Health Q. 2019 May 16;8(3):2. eCollection 2019 May.
No disease-modifying therapy is currently available for Alzheimer's disease, but therapies are in development, and one may become available in the near future. Based on results from early-stage clinical trials, therapeutic development has focused on the hypothesis that Alzheimer's dementia must be prevented rather than cured, because candidate treatments have not been able to reverse the course of dementia. Thus, current trials target patients with early-stage Alzheimer's disease. Were a therapy to become available, patients could undergo first screening for signs of early-stage memory loss or mild cognitive impairment (MCI), testing for the Alzheimer's disease pathology, and then treatment with the aim of halting or slowing progression to Alzheimer's dementia. An important health systems challenge will arise if this new treatment paradigm bears out in late-stage clinical trials. In the 28 European Union countries, we estimate that approximately 20 million individuals over age 55 have MCI, although most people have not been tested for disease pathology. Thus, when a therapy first becomes available, there would be a substantial number of existing (or prevalent) MCI patients who would require screening, diagnosis, and then treatment as quickly as possible to prevent the progression to full-blown Alzheimer's dementia. This research analyzes the preparedness of the health care systems in six European countries-France, Germany, Italy, Spain, Sweden, and the United Kingdom-to ensure timely diagnosis and treatment of patients if a disease-modifying therapy for Alzheimer's becomes available.
目前尚无针对阿尔茨海默病的疾病修饰疗法，但相关疗法正在研发中，且可能在不久的将来问世。基于早期临床试验结果，治疗研发聚焦于这样一种假设，即阿尔茨海默病性痴呆必须预防而非治愈，因为候选治疗方法无法逆转痴呆病程。因此，当前的试验针对早期阿尔茨海默病患者。如果有了一种疗法，患者可首先接受早期记忆丧失或轻度认知障碍（MCI）迹象的筛查，进行阿尔茨海默病病理学检测，然后接受治疗，目标是阻止或延缓向阿尔茨海默病性痴呆的进展。如果这种新的治疗模式在后期临床试验中得到验证，将会出现一个重要的卫生系统挑战。在欧盟28个国家，我们估计约有2000万55岁以上的人患有MCI，不过大多数人尚未接受疾病病理学检测。因此，当一种疗法首次可用时，将会有大量现有的（或普遍存在的）MCI患者需要尽快进行筛查、诊断，然后接受治疗，以防止发展为全面的阿尔茨海默病性痴呆。本研究分析了六个欧洲国家——法国、德国、意大利、西班牙、瑞典和英国——的医疗保健系统的准备情况，以便在有针对阿尔茨海默病的疾病修饰疗法可用时确保及时诊断和治疗患者。
