Improving Understanding of Epidemiology and Impact of Alzheimer’s Disease (Guest blog)

Alzheimer’s disease (AD) is a significant – and growing – public health issue that takes a severe toll on individuals and their families and poses a challenge for global health systems. It is estimated that nearly 8 million people in Europe currently live with dementia.[1] By 2050, that number is expected to rise to 14 million.[2] As populations age, and the proportion of individuals at risk of developing Alzheimer’s or related dementias grows, the socioeconomic burden of Alzheimer’s disease is forecasted to increase exponentially.[3] Importantly, the current data on dementia prevalence does not account for the early stages of AD (hereby referred to as prodromal and preclinical AD) where a majority of people living with the disease demonstrate no apparent symptoms. With interventions in development that could prevent or slow the progression of the disease, policymakers require better data on the current and future AD population to understand the value of these interventions for people living with or at risk of developing Alzheimer’s, their families and society. Estimates of the potentially eligible patient population will support health system preparedness for the entry of effective interventions that could reduce informal care costs.
New research from PAVE sheds light on global prevalence of Alzheimer’s disease
PAVE – a collaborative, multi-stakeholder forum committed to Alzheimer’s disease (AD) research, value assessment and funding in Europe – recently published a research aiming to fill the data gap in estimates of the global Alzheimer’s patient population size by evaluating the prevalence of disease across the Alzheimer’s disease continuum. Specifically, PAVE identified a need to more accurately define the AD stages and improve estimates of the patient population size, with a specific focus on the sub-groups that could benefit from new treatments. Using published evidence and meta-analyses that drew from multiple cohorts, researchers evaluated global prevalence of AD along three pre-defined stages of the AD continuum, including early-stage preclinical and prodromal AD and later-stage AD dementia, and analysed patient demographics at each stage of disease, relying on the presence of a predictive biomarker which can appear many years prior to the onset of clinical signs and symptoms of disease.
The study found that the number of people affected by AD is significantly higher than previous published estimates. In fact, the study suggests that 22% of the global population aged 50 and over – and women more so than men – could benefit from future prevention strategies, including interventions and treatments with potential to stop or slow the progression of AD.
Within Europe, the findings suggest a potentially treatable population of 3.4 million persons, notwithstanding contraindications and other restrictions to treatment eligibility. It suggests that proactive and preventive measures present the best opportunity for extending cognitive function and the ability to live independently and without significant care support. By shedding light on the size of the AD population, including in its earliest stages before symptoms appear, the study provides a starting point for the assessment of non-pharmaceutical interventions aimed at preventing this disease, as well as candidate therapies aimed at modifying the disease progression (Disease-Modifying Therapies or DMTs).
Looking ahead to ensure access
Policymakers globally acknowledge that Alzheimer’s disease is one of the costliest diseases to society. However, the specific calculation of those costs is complex and challenging. New European policies and healthcare programs, in preparation for the availability of disease-modifying therapies, require better understanding of the size and demographics of the early patient population. The findings of PAVE’s study can offer a relevant starting point for future models assessing AD burden and disease distribution across subgroups. Without accurate definitions for subgroups of the AD population or a full understanding of the broader socioeconomic burden of AD, our health care systems are ill-equipped to effectively assess the full value of expected new diagnostic tools and therapies for Alzheimer’s disease. To ensure that a large number of patients in Europe are not left without access to transformative care when a DMT hits the market, national attention to Alzheimer’s and dementia – and the dedicated funding for research and innovation – must be made a priority. PAVE hopes that policy makers and healthcare systems can use this research to inform new policies and programmes for the fight against Alzheimer’s disease.

This blog post is on behalf of PAVE.

About PAVE
PAVE was established to increase collaboration and understanding between key stakeholders in the Alzheimer’s disease ecosystem within Europe, including regulators, bodies responsible for health technology assessment, payers, clinicians, patient advocates, and industry members. PAVE's membership defines the projects and research of PAVE, aimed at developing solutions to the challenges related to value assessment of and funding for emerging Alzheimer’s disease therapies and diagnostics in Europe. The effort is funded by Hoffmann-La Roche (Roche), Biogen and Eli Lilly. The epidemiological study was funded by Roche and Biogen. PAVE is currently conducting research for the purpose of education and collaboration on solutions related to Alzheimer’s disease.

Alzheimer Europe. “Prevalence of Dementia in Europe.” Link
[2] Alzheimer Europe. “Prevalence of Dementia in Europe.” Link
[3] El-Hayek Y, Wiley R, Khoury C, Daya R, Ballard C, Evans A, Karran M, Molinuevo JL, Norton M, & Atri A. “Tip of the Iceberg: Assessing the Global Socioeconomic Costs of Alzheimer’s Disease and Related Dementias and Strategic Implications for Stakeholders.” May 2019. Link