DECODING CLINICAL HEURISTICS IN EARLY ALZHEIMER'S DISEASE: NEUROLOGISTS' PREFERENCES AND TRADE-OFFS IN AMYLOID-TARGETING THERAPY INITIATION
Author(s)
Raquel Sánchez-Valle, Dr1, Elena Garcia-Arcelay2, Guillermo Garcia-Ribas, Dr3, Alberto Villarejo-Galende, Dr4, Neus Canal, N/A5, Mònica Sarmiento, N/A5, Juan Fortea, Dr6, Jorge Maurino, Other7, Gustavo Saposnik, Dr8.
1Department of Neurology, Hospital Clinic, FRCB- IDIBAPS, Universidad de Barcelona, Barcelona, Spain, 2SNC Medical Expert, ROCHE FARMA, Madrid, Spain, 3Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain, 4Department of Neurology,, Hospital Universitario 12 de Octubre, Madrid, Spain, 5RWCS, IQVIA Information, Madrid, Spain, Barcelona, Spain, 6Sant Pau Memory Unit, IR SANT PAU, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain, 7Roche Farma SA, Madrid, Spain, 8Division of Neurology, Department of Medicine, St Michael’s Hospital, University of Toronto. Clinical Outcomes and Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto,, Toronto, Spain.
1Department of Neurology, Hospital Clinic, FRCB- IDIBAPS, Universidad de Barcelona, Barcelona, Spain, 2SNC Medical Expert, ROCHE FARMA, Madrid, Spain, 3Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain, 4Department of Neurology,, Hospital Universitario 12 de Octubre, Madrid, Spain, 5RWCS, IQVIA Information, Madrid, Spain, Barcelona, Spain, 6Sant Pau Memory Unit, IR SANT PAU, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain, 7Roche Farma SA, Madrid, Spain, 8Division of Neurology, Department of Medicine, St Michael’s Hospital, University of Toronto. Clinical Outcomes and Decision Neuroscience Unit, Li Ka Shing Institute, University of Toronto,, Toronto, Spain.
OBJECTIVES: Applying principles from decision neuroscience, this study evaluated the cognitive heuristics and trade-offs governing amyloid-targeting therapy (ATT) initiation in early Alzheimer’s disease (AD). We aimed to identify the clinical factors and treatment attributes that most decisively influence neurologists' therapeutic choices.
METHODS: In collaboration with the Spanish Society of Neurology (SEN), we conducted a cross-sectional, web-based discrete choice experiment (DCE) among practicing neurologists in Spain. Participants evaluated 12 simulated case pairs across 11 variables spanning patient characteristics, biomarkers, and operational attributes. Preference weights were estimated using conditional and mixed logit models. Separate mixed logit interaction models isolated the independent influence of clinician attitudes toward innovation using the Evidence-Based Practice Attitude Scale (EBPAS).
RESULTS: The study evaluated 200 neurologists (mean age: 41.7 years [SD 9.6], median cognitive disorder management experience: 9.0 years [IQR 5.0-16.0]). Conditional logit analysis revealed that pre-existing vascular disease burden on MRI was the primary driver of therapeutic choice (28.7% relative importance weight), followed by patient age (17.2%) and serum p-Tau217 status (15.5%). A low-risk neurovascular MRI profile (mild white matter hyperintensities/absence of microbleeds) strongly increased the likelihood of selecting ATT (Conditional Logit: OR=11.8, p<0.0001; Mixed Logit: OR=14.0, p<0.0001). Mixed logit interaction models showed that high innovation adoption significantly attenuated the traditional aversion to amyloid-related imaging abnormalities (ARIA) and vascular risks. Innovative neurologists (n=105, 52.5%) demonstrated a lower aversion to pre-existing structural ARIA risk factors on MRI (OR=0.30, p=0.0005) and were more willing to initiate treatment despite baseline vascular comorbidities (OR=2.24, p=0.0005).
CONCLUSIONS: Neurologists generally rely on a risk-averse heuristic for ATT initiation, operating within a safety-first framework that prioritizes mitigating structural ARIA risk over operational feasibility. However, clinicians with highly innovative profiles minimize traditional neuroimaging and vascular constraints to prioritize proactive, early intervention.
METHODS: In collaboration with the Spanish Society of Neurology (SEN), we conducted a cross-sectional, web-based discrete choice experiment (DCE) among practicing neurologists in Spain. Participants evaluated 12 simulated case pairs across 11 variables spanning patient characteristics, biomarkers, and operational attributes. Preference weights were estimated using conditional and mixed logit models. Separate mixed logit interaction models isolated the independent influence of clinician attitudes toward innovation using the Evidence-Based Practice Attitude Scale (EBPAS).
RESULTS: The study evaluated 200 neurologists (mean age: 41.7 years [SD 9.6], median cognitive disorder management experience: 9.0 years [IQR 5.0-16.0]). Conditional logit analysis revealed that pre-existing vascular disease burden on MRI was the primary driver of therapeutic choice (28.7% relative importance weight), followed by patient age (17.2%) and serum p-Tau217 status (15.5%). A low-risk neurovascular MRI profile (mild white matter hyperintensities/absence of microbleeds) strongly increased the likelihood of selecting ATT (Conditional Logit: OR=11.8, p<0.0001; Mixed Logit: OR=14.0, p<0.0001). Mixed logit interaction models showed that high innovation adoption significantly attenuated the traditional aversion to amyloid-related imaging abnormalities (ARIA) and vascular risks. Innovative neurologists (n=105, 52.5%) demonstrated a lower aversion to pre-existing structural ARIA risk factors on MRI (OR=0.30, p=0.0005) and were more willing to initiate treatment despite baseline vascular comorbidities (OR=2.24, p=0.0005).
CONCLUSIONS: Neurologists generally rely on a risk-averse heuristic for ATT initiation, operating within a safety-first framework that prioritizes mitigating structural ARIA risk over operational feasibility. However, clinicians with highly innovative profiles minimize traditional neuroimaging and vascular constraints to prioritize proactive, early intervention.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MSR17
Topic
Methodological & Statistical Research
Topic Subcategory
PRO & Related Methods
Disease
Neurological Disorders