Is Australia ready for the rollout of amyloid-targeting therapies for Alzheimer disease? Results from a national survey characterising current infrastructure capability, workforce and training needs of memory and cognition clinics

Abstract

Background

New amyloid-targeting monoclonal antibody (mAb) therapies for Alzheimer disease (AD) are currently under review by the Therapeutic Goods Administration for use in Australia.

Aims

To determine the infrastructure, workforce and training needs of Australian memory and cognition clinics in order to characterise health system preparedness for these therapies.

Methods

A national, cross-sectional online survey of medical specialists.

Results

Thirty medical specialists (geriatricians, n = 23; psychiatrists, n = 4; neurologists, n = 3) from 30 different clinics participated (public, 76.7%; private, 23.3%), including from metropolitan (73.3%), regional (20.0%) and rural (6.7%) areas. On average, clinics reported assessing 5.4 (SD = 3.2) new patients per week, of which 2.4 (range: 0–5) were considered to have mild cognitive impairment (MCI). Only 40% of clinics use biomarkers to assess whether patients with MCI have AD, and 45% have intravenous infusion capability. While the majority of clinicians were confident in their knowledge of mAbs, only 33% felt confident in using these. Identified impediments to clinical implementation included (i) lack of real-world experience, (ii) lack of current Models of Care and appropriate use guidelines, (iii) current clinic set-up and (iv) information about safety.

Conclusions

Australia's health system preparedness for amyloid-targeting mAb therapies will require further investment in infrastructure, equity of access, clinician training and support. Long wait times already impact access to clinics, and with the forecast rise in MCI and dementia cases, services will need to be expanded, and appropriate Models of Care and clear and efficient inter-sector health pathways will be needed to prepare for the use of mAbs.