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People get ready! A new generation of Alzheimer’s therapies may require new ways to deliver and pay for healthcare

Wahlberg K, Winblad B, Cole A, Herring WL, Ramsberg J, Torontali I, Visser P-J, Wimo A, Wollaert L, Jönsson L

The development of disease-modifying therapies (DMTs) for Alzheimer’s disease (AD) has progressed over the last decade and the first ever therapies with potential to slow the progression of disease are approved in the US. AD DMTs could provide life-changing opportunities for people living with this disease, as well as for their caregivers. They could also ease some of the immense societal and economic burden of dementia. However, AD DMTs also come with major challenges due to the large unmet medical need, high prevalence of AD, new costs related to diagnosis, treatment and monitoring, and uncertainty in the therapies’ actual clinical value.

In November 2022, a seminar financed by Journal of Internal Medicine was organised at Karolinska Institutet in Sweden to provide a critical assessment of the applicability of innovative payment models to overcome the financial barriers of AD DMTs. It also aimed to develop proposals for which models can be considered under different circumstances. The seminar represented a range of stakeholders including industry, academia, health care providers, health technology assessment bodies and research funding organizations.

This perspective article summarises some of the discussions from the seminar on innovative payment models for AD DMTs; it also provides a broader perspective on society’s readiness for AD DMTs. The authors propose that innovative payment models such as performance-based payments, in combination with learning healthcare systems, could be the way forward to enable timely patient access to treatments, improve accuracy of cost-effectiveness evaluations and overcome budgetary barriers. Other important considerations include the need for identification of key drivers of patient value, the relevance of different economic perspectives (i.e., healthcare vs societal) and ethical questions in terms of treatment eligibility criteria.

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Journal of Internal Medicine, 2023;0:1-11
DOI: 10.1111/joim.13759