Estimates of current capacity for diagnosing and implementation of new treatment Alzheimer's disease in Slovenia

Background The limited efficacy of current symptomatic treatments for Alzheimer's disease (AD) leads many patients to forgo medical help. However, new disease-modifying treatments (DMTs), such as donanemab and lecanemab, show potential to change this. Objective To model the impact of these treatments on Slovenia's healthcare system by analyzing patient flow under both current and enhanced capacities, assuming DMT availability. Methods The study estimates 76,923 potential DMT candidates aged 65 years and older with mild cognitive impairment or mild AD. Using data from Slovenia's three specialized centers for cognitive disorders, a Markov model simulated five five-year scenarios: baseline, real-life, real-life with capacity enhancement, biomarker integration, and biomarker integration with capacity enhancement. Results Waiting times for specialist evaluation would increase from the current 3–12 months to 1.8 years. The primary bottleneck is lumbar puncture with cerebrospinal fluid (CSF) analysis, during which 64% of patients would become ineligible for DMT. The shortest waiting time to receive DMT occurs in the biomarker integration with capacity enhancement scenario, at 4 years, reducing ineligibility to 7%. Conclusions Current specialized outpatient facilities are limited, causing significant bottlenecks, especially in CSF analysis. Severe waiting times under current capacities mean many patients would progress to moderate or severe dementia or die before receiving treatment. Plasma biomarkers offer a promising triage approach to guide patients toward lumbar puncture or other confirmatory diagnostics, potentially easing this critical bottleneck. Substantial infrastructure and workforce improvements are essential to ensure timely and equitable access to DMTs in Slovenia.