Identifying facility-level and infrastructure-level bottlenecks in Japan's lecanemab rollout through an online survey of dementia specialists.

BACKGROUND

The approval of lecanemab has created new operational demands for Alzheimer's disease care. Japan's nationwide rollout under universal health insurance offers an opportunity to identify real-world bottlenecks in treatment delivery.

OBJECTIVE

To identify facility-level and infrastructure-level factors associated with wait time to initial lecanemab infusion and treated patient volume among dementia specialists in Japan.

METHODS

We performed a secondary analysis of an anonymous online survey of 296 dementia specialists certified to prescribe lecanemab in Japan approximately one year after approval. We examined associations between physician/facility characteristics, diagnostic and infusion resources, perceived implementation barriers, and two delivery metrics: wait time from first consultation to first infusion and number of treated patients per respondent. Bayesian accelerated failure-time and zero-truncated Poisson mixed-effects models were used.

RESULTS

Approximately 80% of respondents reported average wait times of 3 months or less, whereas the median treated caseload was modest at 5 patients per physician. Perceived mismatch between treatment capacity and demand was associated with longer wait time (time ratio 1.323, 95% credible interval 1.045-1.682). Cerebrospinal fluid (CSF)-dominant amyloid-testing strategies tended to be associated with smaller caseloads, while in-house CSF testing and APOE testing were associated with larger caseloads. High-volume centers reported constrained outpatient infusion space. Lack of reimbursement for infusion-related tasks and APOE testing were perceived as major system-level barriers.

CONCLUSIONS

Japan's rollout may be constrained by some bottlenecks in diagnostics, infusion infrastructure, and uncompensated tasks. Appropriate policy interventions might help secure equitable access to the treatment.