Preparedness of China's health care system to provide access to a disease-modifying Alzheimer's treatment

INTRODUCTIONAlthough the majority of patients with Alzheimer's disease (AD) reside in low-and middle-income countries, little is known of the infrastructure in these countries for delivering emerging disease-modifying treatments. METHODSWe analyze the preparedness of China, the world's most populous middle-income country, using desk research, expert interviews and a simulation model. RESULTSOur findings suggest that China's health care system is ill-prepared to provide timely access to Alzheimer's treatment. The current pathway, in which patients seek evaluation in hospital-based memory clinics without a prior assessment in primary care, would overwhelm existing capacity. Even with triage using a brief cognitive assessment and a blood test for the AD pathology, predicted wait times would remain over 2 years for decades, largely due to limited capacity for confirmatory biomarker testing despite adequate specialist capacity. DISCUSSIONClosing this gap will require the introduction of high-performing blood tests, greater reliance on cerebrospinal fluid (CSF) testing, and expansion of positron emission tomography (PET) capacity.