The development of disease-modifying therapies (DMTs) for Alzheimer's disease (AD) has progressed over the last decade, and the first-ever therapies with potential to slow the progression of disease are approved in the United States. AD DMTs could provide life-changing opportunities for people living with this disease, as well as for their caregivers. They could also ease some of the immense societal and economic burden of dementia. However, AD DMTs also come with major challenges due to the large unmet medical need, high prevalence of AD, new costs related to diagnosis, treatment and monitoring, and uncertainty in the therapies’ actual clinical value. This perspective article discusses, from the broad perspective of various health systems and stakeholders, how we can overcome these challenges and improve society's readiness for AD DMTs. We propose that innovative payment models such as performance-based payments, in combination with learning healthcare systems, could be the way forward to enable timely patient access to treatments, improve accuracy of cost-effectiveness evaluations and overcome budgetary barriers. Other important considerations include the need for identification of key drivers of patient value, the relevance of different economic perspectives (i.e. healthcare vs. societal) and ethical questions in terms of treatment eligibility criteria.

中文翻译：

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大家准备好！新一代阿尔茨海默病疗法可能需要新的方式来提供和支付医疗保健费用

过去十年，阿尔茨海默病 (AD) 的疾病缓解疗法 (DMT) 的开发取得了进展，美国批准了有史以来第一种有可能减缓疾病进展的疗法。 AD DMT 可以为患有这种疾病的人及其护理人员提供改变生活的机会。它们还可以减轻痴呆症带来的巨大社会和经济负担。然而，由于大量未满足的医疗需求、AD 的高患病率、与诊断、治疗和监测相关的新成本以及疗法实际临床价值的不确定性，AD DMT 也面临着重大挑战。这篇观点文章从各个卫生系统和利益相关者的广泛角度讨论了我们如何克服这些挑战并提高社会对 AD DMT 的准备程度。我们建议，基于绩效的支付等创新支付模式与学习型医疗保健系统相结合，可能成为使患者及时获得治疗、提高成本效益评估准确性并克服预算障碍的前进方向。其他重要的考虑因素包括需要确定患者价值的关键驱动因素、不同经济观点（即医疗保健与社会）的相关性以及治疗资格标准方面的伦理问题。