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Improving health and economic outcomes via the timely diagnosis of dementia

Steve Parr IXICO

Dementia Workshop Nowgen, Manchester 11.9.13

www.ixico.com Confidential, IXICO Ltd. 2013

Agenda

- Who are IXICO?

- Focus Group Output

- The Need for Timely Diagnosis

- NHS Pilots

- Actionable Information

- Questions

2


IXICO Overview

Medical imaging company based in London with global reach • Founded in 2004 by KCL, Imperial College and UCL KOLs

• Worked with 7 of the top 14 pharma companies – e.g. on high profile global drug trials in AD

• Worked with 450 imaging centres globally

• Managed over 40 clinical studies and process 1000’s of images every year

We provide imaging biomarkers for use in:

• Clinical trials & research studies (to enrich study populations, evaluate target engagement, and assess drug safety and efficacy)

• Healthcare to support disease diagnosis Product portfolio

• Image management platform - regulatory compliant image data management and processing in clinical trials

• Image analysis packages, delivering automated quantitative analysis

• CE marked medical device for use in clinical practice 3


Dementia

Our Digital Healthcare Platform for dementia is being deployed as an approved medical device within the NHS and by Key Opinion Leaders elsewhere in Europe We have UK government support to:

• Pilot the deployment of our technology within the NHS

• Establish the business opportunity in China

We have been working as a key member of the Coalition Against Major Diseases consortium to qualify imaging biomarkers with regulators IXICO CEO, Prof. Derek Hill, is a member of the Prime Minister’s Research Champion Group for Dementia

4

IXICO / Alzheimer’s Society focus group session


Sample Vignettes W

ife

of

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t d

iagn

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d

wit

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a • The patient had a history of brain cancer

• The diagnostic process took 2 years and the concerns regarding dementia were raised by the carer herself

• Once the diagnosis was received, we were left without information. The carer did the research herself and found Alzheimer’s Society

Wif

e o

f p

atie

nt

dia

gno

sed

w

ith

de

men

tia • GP referred to a psychiatrist. Long

waiting list, consultation not useful

• Went to an expensive private psychiatrist

• GP said that the symptoms were cause by “stress” and referred them to couple counselling

• Finally referred to a geriatric clinic and obtained diagnosis after 3 years

• No information given - were advised to talk to a relevant ‘association’


Sample Vignettes G

ran

dd

augh

ter

of

pat

ien

t d

iagn

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d w

ith

dem

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a • Initial diagnosis was depression because the patient was considered too young for dementia

• The diagnosis of early onset dementia was obtained after 5 years

• The family had to push for a diagnosis and did not receive the information needed when the diagnosis was finally received

Dau

ghte

r o

f p

atie

nt

dia

gno

sed

wit

h d

emen

tia • Patient was prescribed

Aricept at the hospital

• Family and patient never received a proper diagnosis

• The word “dementia” was never said


Sample Vignettes So

n o

f p

atie

nt

dia

gno

sed

wit

h

de

men

tia • Diagnosis obtained within

a couple of months at a memory clinic

• Patient and carer left with no information or support once the diagnosis obtained

Hu

sban

d o

f p

atie

nt

dia

gno

sed

wit

h d

emen

tia • The symptoms onset was

brutal with delusions

• GP immediately referred to psychiatrist and the patient was diagnosed with classic AD


Summary

How did you and your partner feel on receiving the diagnosis?

“Shattered, depressed, alone, catastrophe, life sentence of doom”

“Relief” “Pleased to have a name on his illness”

The Need for Timely Diagnosis


Background

Current prevalence: • In the UK 800,000 people live with

dementia (>50% undiagnosed)

With an ageing population: • In 30 years ~ 1.4m in the UK will have

dementia

Significant costs • In the UK dementia costs £23 billion a

year (medical, social care & lost productivity)

• This is more than cancer and heart disease combined


The Need for Timely Diagnosis

A timely diagnosis:

“gives people greater control over their lives and allows them to plan for the future and manage their condition more effectively.” “ It opens the door to treatments which can help people to recognise their loved ones or play with their grandchildren for longer” “…. is a key element in providing cost-effective dementia services.”

12


The Economic Case for Diagnosis with Current Interventions

Savings are substantial compared with treatment without early assessment, averaging:

• £2,100 in health care costs,

• £5,700 in societal costs

13

Alzheimer’s & Dementia 2012

Primary and secondary care dementia diagnosis NHS pilots


A Typical UK Dementia Patient Journey can be Long and Complex

Multiple repeat assessments with inconclusive appointments

Waiting lists vary from 2 weeks to ~ 1 year

60% of patients wait > 1 year to complete the diagnostic process

This situation will worsen as referrals from GPs rise


Current situation


GP

Memory Clinic Weekly Team Meeting (1) Referral acceptance

If referral not accepted, patient sent back to GP

Clinical Assessment (at patient’s home or memory clinic)

Memory Clinic Weekly Team Meeting (2) Patient report is discussed

Decision if further examinations (incl. MRI) is required

MRI and radiological read

Memory Clinic Weekly Team Meeting (3) Decision on diagnosis

Meeting with the patient Diagnosis, treatment and care plan

GP is requested to prescribe treatment

Maudsley Memory Clinic Pilot Pathway


‘Brain Health Centre’ Pilot

• Brain Health Centre model is currently being piloted in a community/primary care setting in the NHS

• Funding from the MRC/Technology Strategy Board Biomedical Catalyst initiative

• Mobile and fixed facilities

18

The BHC combines: • Computerized cognitive assessment • Depression and functional assessments • MRI measure of neurodegeneration • MRI measure of Vascular Disease

The BHC provides age-referenced reports to add confidence to differential diagnosis AD v. Vascular v. ‘Other’


Cognitive Testing MRI

GP • MMSE • Functional Qs • Blood tests

Phone call and home Visit by Study Co-ordinator

Consent for

Consent

Consent

CT Scan

Memory Assessment Service:

• Psychiatrists • GP • MAC Healthcare

CANTAB

Neurology

• Diagnosis • Care plan

Unusual cases

Yes

No

Yes

No

Patient

Randomisation

50 % 50 %

Via GP

BHC Pilot Pathway


Accelerating Pathways

20


The Power of Integrated Technologies

• Primary care triage prioritises those with a likely degenerative condition • Brain Health Centre assessment helps rapid diagnosis of the majority of cases

Enabling patients and their doctors to make informed, individualized care decisions


Benefits of this Solution

Shortens time to accurate diagnosis from up-to 18 mths. to around 3 mths.

Provides objective data to support diagnosis earlier in the disease course

Adds confidence to differential diagnosis (e.g. vascular dementia v. Alzheimer’s Disease v. Other)

Enables diagnosis of the majority of dementia cases within primary care

22

Improves health and social outcomes

Earlier accurate diagnosis allows patients and their carers to access effective interventions that can extend independent living by up to 18 mths.

Early accurate diagnosis can save ~ £8,000 per patient in health and social care costs

Diagnosis Patient Care


Future Developments

Current R&D includes:

• Sensitive measurements of Vascular Disease

• Quantification of structural brain asymmetry – Frontotemporal Dementia

• Quantification of brain amyloid load (PET)

• Study on halting the progression of MCI/prodromal AD symptoms (SCarlet RoAD study)

• Integrating our imaging technology with other diagnostic technologies:

− Computerized cognitive testing − EEG

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Actionable Information - Sample Patient Reporting

www.ixico.com Confidential, IXICO Ltd. 2013 25

Patient Report - Summary


Patient Report

www.ixico.com Confidential, IXICO Ltd. 2013 27

Patient Report - Cognition


Patient Report – Imaging


Patient Report – Imaging


Quantitative MRI

Quantitative analysis of MRI volumes is now regulatorily used in clinical trials phase I – III

MRI is widely used, relatively cheap and non-invasive

Regulatory qualification of biomarkers

• EMA qualified low hippocampal volume for enriching clinical trial of AD in the pre-dementia phase

Widely available and often clinically recommended Recommended as a biomarker to support diagnosis by recent working groups

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Dementia Reference Database

Data collected from large natural history studies and other research studies Includes data from different patient populations

• Disease states - Normal, MCI and AD populations

• Age range 50 – 90

• Male and Female

• Western and Asian populations

Data includes:

• Demographic, clinical, imaging and cognitive measures.

• Longitudinal assessment (progression / conversion) The database is being continuously expanded as the tools are used and through research and development activities.

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Thank you For further information, please contact me directly:- Steve Parr IXICO Ltd. E: [email protected] M: 07791 935204

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