Imagine watching your loved one slip away from you, slowly losing their memory until they can’t hold a conversation or respond to the environment around them. Unfortunately, this is a reality for many people who have a family member with Alzheimer’s disease, a progressive and irreversible brain disorder that is the most common cause of dementia in older adults. While dementia is more common as people grow older, it is not a normal part of aging.

Alzheimer’s disease is one of the greatest public health challenges of our time — like cancer, every Canadian is likely to know someone close to them who is or will suffer from Alzheimer’s disease. Over a half million Canadians are currently living with dementia, and 25,000 new cases are diagnosed every year. Of those cases, it is estimated that between 60-70% are suffering from Alzheimer’s disease. And this is just the beginning. It is estimated that by 2031, these numbers will increase by 66%.

Currently, the only approved treatments for Alzheimer’s disease help to alleviate symptoms stemming from the disease but they do not stop the disease from progressing over time. There are no Alzheimer’s therapies that modify the disease, reverse or stop its effects. Alzheimer's disease drug candidates have one of the highest failure rates of any disease area – 99.6%, compared with 81% for cancer. For most people, significant structural and functional damage to the brain has already occurred by the time they are diagnosed, which limits options for any form of recovery after symptoms present.

At Roche, our goal is to transform scientific insights into breakthrough medicines and novel diagnostics for people with neurological conditions, as we have done for people with cancer. Our focus and priority is on conditions with unmet medical need, such as Alzheimer’s disease. We have learned a lot from new science and our own experience working in this area. And while we are getting closer to the development of disease-modifying therapies, we recognize that the current healthcare system is ill-prepared for the introduction of potential treatments. It’s important that we identify and begin addressing these systemic gaps now so that patients can immediately benefit from treatment if there is one available. The changes that are required go well beyond Alzheimer’s disease and ultimately need to meet the needs of Canada’s aging population.

Understanding the Current Landscape

To take a closer look at this issue, we have undertaken a number of initiatives to understand the impact the introduction of a disease modifying therapy will have on the Canadian healthcare system. We recently hosted a panel with experts in Alzheimer’s disease, which uncovered capacity gaps across the continuum of care from diagnosis to treatment. Considering the large number of patients who may be interested in exploring new treatment options, this panel spoke to the lack of imaging infrastructure and resources — such as the availability of positron-emission tomography (PET) machines — leading to potentially significant wait times for patients, resulting in delayed diagnoses. Physician education and comfort with tests not commonly used in current clinical practice, as well as access to neurologists and infusion clinics will also grow to be a challenge.

One potential solution panel members put forward was the role primary care physicians could play in this space. According to a study conducted by the Canadian Institute for Health Information and the Public Health Agency of Canada, only 40% of primary care physicians feel equipped to adequately deal with patients with dementia. As Dr. Soeren Mattke, Director of the Center for Improving Chronic Illness Care at the University of Southern California explained, “One of the biggest opportunities is primary care physicians. Specialists require eight years of training and there are very few across the country, but there are many people in the primary care setting who could help lessen this burden.” This sentiment was echoed by Dr. Jennifer Ingram, a geriatrician from the Kawartha Centre who explained “There have been many federal and provincial strategies, as well as four Canadian Consensus Conferences on Diagnosis and Treatment of Dementia. All reinforce the pivotal role of primary care physicians in early detection and diagnosis of dementia and Alzheimer’s.”

While this discussion was an important first step to understanding the challenges within the healthcare system, we continue to build on these insights and look at potential opportunities for improvement in the short, medium and long term. Knowing that healthcare is implemented provincially, we are working to understand existing capacity, including access to imaging, neurologists, and infusion clinics in light of the number of people who could benefit from treatment. We are also engaging healthcare practitioners and leading academics to better understand challenges around Alzheimer’s diagnoses and how we can use existing infrastructure more effectively.

Drawing on Experience

We know that early diagnosis is key if we are to slow down the progression of the disease in Alzheimer’s patients before symptoms become apparent and have a significant impact on quality of life. While many challenges are unique to Alzheimer’s, we can look to other disease areas for inspiration and best practices. There are a number of parallels between Alzheimer’s disease today and cancer a number of years ago. As Pauline Tardif, CEO of the Alzheimer Society of Canada explained, “In oncology, early prevention programs and early screening programs have been implemented, so this is possible for Alzheimer’s. The health system will need to be responsive.”

Building on our experience in oncology, we believe Roche has a lot to offer in terms of shifting health system policies to accommodate a new standard of care and help patients access innovative diagnostics and therapies. While HER2 positive cancer was uncharted territory for Canada 30 years ago, personalized approaches to cancer treatment are now the norm, and today we’re working with interested stakeholders to ensure that comprehensive genomic profiling is the mainstay of cancer diagnosis and treatment. We can apply these learnings to Alzheimer’s to ensure that innovations — across industry — make a difference in how people live with this debilitating disease.

The challenges are significant and can’t be solved by one organization or stakeholder — we need to work together as partners in the healthcare system. Given the immense personal impact, for the individual and their family, and the enormous societal costs that result from a diagnosis of Alzheimer’s disease, we urgently need to examine the balance of economic burden, social care costs and medical costs through a new lens.

February 28, 2019


Previous In Focus posts