Dissonance in the face of Alzheimer's disease breakthroughs: clinician and lay stakeholder acceptance, concerns and willingness to pay for emerging disease-modifying therapies

• Published in: British journal of psychiatry 2024-06, Vol.224 (6), p.230-236
• Main Authors: Kinchin, Irina, Walsh, Sharon, Dinh, Rachel, Kapuwa, Margaret, Kennelly, Sean P., Miller, Ann-Marie, Nolan, Ann, O'Dowd, Sean, O'Philbin, Laura, Timmons, Suzanne, Leroi, Iracema
• Format: Article
• Language: English
• Subjects: Acceptance; Access; Alzheimer's disease; Aversion; Brain; Clinical effectiveness; Cost analysis; Dementia; Dementia disorders; Disease prevention; Efficacy; Health care; Health care policy; Health insurance; Likert scale; Medical diagnosis; Medical personnel; Neurodegenerative diseases; Old Age; Original Article; Patients; Policy making; Population; Professional attitudes; Professionals; Regression analysis; Risk perception; Willingness to pay; Wisdom
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.2024.24

Introducing new disease-modifying therapies (DMTs) for Alzheimer's disease demands a fundamental shift in diagnosis and care for most health systems around the world. Understanding the views of health professionals, potential patients, care partners and taxpayers is crucial for service planning and expectation management about these new therapies. To investigate the public's and professionals' perspectives regarding (1) acceptability of new DMTs for Alzheimer's disease; (2) perceptions of risk/benefits; (3) the public's willingness to pay (WTP). Informed by the 'theoretical framework of acceptability', we conducted two online surveys with 1000 members of the general public and 77 health professionals in Ireland. Descriptive and multivariate regression analyses examined factors associated with DMT acceptance and WTP. Healthcare professionals had a higher acceptance (65%) than the general public (48%). Professionals were more concerned about potential brain bleeds (70%) and efficacy (68%), while the public focused on accessibility and costs. Younger participants (18-24 years) displayed a higher WTP. Education and insurance affected WTP decisions. This study exposes complex attitudes toward emerging DMTs for Alzheimer's disease, challenging conventional wisdom in multiple dimensions. A surprising 25% of the public expressed aversion to these new treatments, despite society's deep-rooted fear of dementia in older age. Healthcare professionals displayed nuanced concerns, prioritising clinical effectiveness and potential brain complications. Intriguingly, younger, better-educated and privately insured individuals exhibited a greater WTP, foregrounding critical questions about healthcare equity. These multifaceted findings serve as a guidepost for healthcare strategists, policymakers and ethicists as we edge closer to integrating DMTs into Alzheimer's disease care.