Public perceptions related to healthcare preparedness to anti-amyloid therapies for Alzheimer's Disease in Japan

Abstract

Background: The approval of lecanemab, an anti-amyloid therapy for Alzheimer's disease (AD), necessitates addressing healthcare preparedness for disease-modifying treatment (DMT) to ensure appropriate, safe, and sustainable drug administration. Understanding public perceptions on this matter is crucial. We aimed to assess discrepancies and similarities in the perceptions of Japanese trial-ready cohort study ('J-TRC webstudy') participants and clinical specialists in the fields of dementia treatment and radiology, concerning affairs related to challenges in DMT preparedness.

Methods: This was a cross-sectional prospective observational study conducted in November-December 2023. The J-TRC webstudy participants were invited to participate in an online survey using Google Forms, and clinical specialists were invited to complete a mail-based survey. Main questionnaire items had been designed to be common in both surveys, and their responses were analyzed for participant attributes, interests, attitudes, expectations, and concerns about DMTs without specifying lecanemab.

Results: Responses were obtained from n = 2,050 J-TRC webstudy participants and n = 1,518 clinical specialists. Compared to specialists, more J-TRC respondents perceived the eligible proportion for DMT as smaller (59.1% versus 30.7%), perceived the eligible severity for DMT as more limited (58.0% versus 24.5%), and perceived the efficacy of DMT as slightly more encouraging (29.3% versus 34.8%). In terms of treatment prioritization, both J-TRC respondents and specialist respondents exhibited similar levels of acceptance for prioritizing patients to treat: e.g., approximately two-thirds endorsed patient prioritization under hypothetical resource constraints or other reasons. A medical rationale emerged as the most compelling reason for acceptance of patient prioritization across the surveys. In contrast, the need to address vulnerable populations was the reason that led to the least acceptance of prioritization, followed by economic considerations.

Conclusions: Our findings offer valuable insights into the discrepancies in knowledge and perception between patients and healthcare providers. This could enhance the delivery of patient information in clinical settings and inform the discussion surrounding patient prioritization strategies.

Keywords: Disease-modifying therapy; Online survey; Patient prioritization; Public perceptions; Trial-ready cohort.

Fig. 1

Histograms of Likert scale for the perception about DMT (Q17-Q21). Compared to specialists in dementia treatment, J-TRC webstudy participants had less subjective knowledge about DMT (Q17). Meanwhile, J-TRC participants showed a more disappointing impression of the eligibility of DMT drugs than specialists in dementia treatment (Q19, Q20), while specialists in radiology had no difference in their impression of DMT eligibility compared to the specialists in dementia treatment. In terms of the degree of efficacy (Q21), J-TRC participants had a slightly positive impression than specialists in dementia treatment. These results are also summarized in Additional file 3

Fig. 2

Distribution of perception about patient and facility prioritization (Q41-Q45). Acceptance towards prioritization showed largely similar results both in J-TRC participants and specialists. For prioritization in a general term (Q41), allowing prioritizing both facilities and patients was the most prevalent choice selected either by J-TRC participants, specialists in dementia treatment, and specialists in radiology. Acceptance towards prioritization of facilities ([b] & [d]) was expressed by 52.4% of J-TRC respondents, 85.7% of dementia treatment specialists, and 76.2% of radiology specialists. Meanwhile, acceptance towards prioritization of patients ([c] & [d]) was expressed by 65.9% of J-TRC respondents, 67.6% of dementia treatment specialists, and 63.6% of radiology specialists

Fig. 3

Mixed logistic regression analysis for pros/cons about prioritizing patients or facilities in each dataset. Compared to the acceptance of prioritization in terms of medical rationale, economical aspects was consistently less likely to cause acceptance towards prioritizing patients (A, approximately 0.4–0.5 of OR) across the examined surveys, and addressing vulnerable individuals was the reason that consistently accompanied least likelihood to accept for prioritizing patients (A, approximately 0.2 of OR). Meanwhile, compared to the acceptance of prioritization in terms of medical rationale, addressing vulnerable people or the impact on patients’ lives showed significantly lowered likelihood to accept for prioritizing facilities (B) across the examined surveys consistently, while the economical aspects did not show significant increase or decrease in OR as a focus to accept for facility prioritization (i.e., 95%CI overlapping with the OR = 1). Abbreviations: J-TRC, Japanese trial-ready cohort; CI, confidence interval