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Alzheimer's Association International Conference 2026

July 12-15, 2026 | London, United Kingdom, and Online

6361

Early Adoption Of Amyloid-targeting Therapies For Alzheimer's Disease: Utilization Patterns And Demographic Differences In Epic Cosmos

Preview of Early Adoption Of Amyloid-targeting Therapies For Alzheimer's Disease: Utilization Patterns And Demographic Differences In Epic Cosmos

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Poster Presenter

Joseph Januszewicz

Authors

Joseph Januszewicz, Nicole Fowler, Matthew Mackwood, Elliott Fisher, Emma Dean, Paweł Smoliński, Karen Schifferdecker

Affiliations

The Institute for Health Policy and Clinical Practice at the Dartmouth Geisel School of Medicine, Department of Medicine at the Indiana University School of Medicine, Center for Aging Research at the Regenstrief Institute, Department of Community and Family Medicine at the Dartmouth Geisel School of Medicine, The Institute for Health Policy and Clinical Practice at the Dartmouth Geisel School of Medicine, Department of Community and Family Medicine at the Dartmouth Geisel School of Medicine, Department of Economics at the University of Gdańsk

Part of Topic

Video

Title: Early Adoption of Amyloid-targeting Therapies for Alzheimer’s Disease: Utilization Patterns and Demographic Differences in Epic Cosmos

Key Finding: Despite early predictions of significant spending on new Alzheimer’s medications, fewer than 1% of MCI or AD-diagnosed patients initiated amyloid treatment between 2022-25. Differences in demographics are evident in early treatment adoption which may reflect clinically appropriate decision-making and/or structural barriers to accessing care.

Background:

•Medicare approved coverage of amyloid-targeting Alzheimer’s therapies Lecanemab in 2023 and Donanemab in 2024

•These medications are expensive and require early diagnosis, biomarker confirmation, and safety monitoring

•Centers for Medicare & Medicaid Services (CMS) estimated costs of between $2 billion and $5 billion annually from such treatments

Research Objective: To examine utilization trends in clinical practice across the care cascade, from diagnosis to neurology referral to treatment

Study Design:

•Retrospective cohort design. Epic electronic health record-enrolled and participating hospitals, Jan 1, 2022-Dec 31, 2025.

•Age 65+ with new diagnosis of mild cognitive impairment (MCI) or Alzheimer’s Disease (AD)

Data Source: Epic Cosmos Dataset: large US electronic health record network representing approximately half of US health systems

Approach:

Examined sociodemographic at specific stages of treatment:

•Diagnosis (Mild Cognitive Impairment or Alzheimer’s using ICD-10)

•Neurologist referral (<3 months and <6 months)

•Treatment (Lecanemab or Donanemab)

Results/Discussion:

•Of over 1,667,913 patients diagnosed between 2022 and 2025, only 14,628 (or 0.88%) received Alzheimer’s amyloid treatment. This number was higher (1.08%) among those with an MCI diagnosis vs (0.64%) without. Approximately 39% of patients saw a neurologist within six months of an initial MCI or Alzheimer’s diagnosis.

•Patients aged 85+ had substantially lower treatment rates (RR: 0.08) compared to those aged 65-74, Black or African American patients also had lower treatment rates (RR: 0.22) compared to White patients. Differences by sex or rurality were small.

•Use of Lecanemab doubled in its first year of approval (2,495 to 5,263) with Donanemab uptake also doubling in its first year (1,836 to 4,013) but uptake for both medications remans low.

Figure titles:

Figure 1 (right). Alzheimer’s Amyloid Treatment Pathway (1.2022-12.2025)

Figure 2 (below). Alzheimer’s Amyloid Treatment Uptake Over Time (1.2023-12.2025)

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