OBJECTIVES : Disease-modifying therapies (DMTs) for Alzheimer’s disease (AD) are expected to affect patients, caregivers, healthcare systems, and wider society. The aim of this review was to explore the potential impact of DMTs and understand the assumptions and limitations of these predictions.

METHODS : A targeted literature review was conducted in December 2018 to identify studies which modeled the future impact of DMTs. Searches were conducted in literature databases (MEDLINE, Embase, and EconLit, 2008 onwards) and gray literature sources.

RESULTS : Twenty-one studies were identified with varying aims, methods, data, geography, and funding. Key differences were observed in the patient population assumed to be treated (pre-AD, mild cognitive impairment, diagnosed AD) and the hypothetical treatment effect (delayed disease development, modified rate of progression, or absolute prevention; and the magnitude of this effect). Depending on the treatment effect, DMTs were predicted to impact on the size of the AD population; also to decrease the proportion of patients with severe AD, and increase survival and quality-adjusted life-years. DMTs may produce cost savings overall; these anticipated cost savings will be primarily in social and informal care. Analyses highlighted that therapy uptake and healthcare system capacity limitations may affect the impact of DMTs. Areas of uncertainty in identified studies included the duration, timing, and therapeutic effect of DMTs, treatment costs, logistics of diagnosis and treatment, baseline AD prevalence, and the impact of AD on mortality.

CONCLUSIONS : Overall, current literature suggests DMTs for AD could have a major impact on patients, their caregivers, and wider society, but health systems will need to prepare for their introduction to maximize their benefit. Further work will be required to understand these benefits when the treatment effects and candidate patient populations can be better defined.