Is Australia ready for the rollout of amyloid-targeting therapies for Alzheimer's 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's 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 to characterise health system preparedness for amyloid-targeting mAb therapies for AD. Methods: A national, cross-sectional online survey of medical specialists was conducted. 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 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 55% 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 a) lack of real-world experience; b) lack of current Models of Care and appropriate use guidelines; c) current clinic set-up; and d) 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; while appropriate models of care and clear and efficient inter-sector health pathways will be needed to prepare for the use of mAbs.