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
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www.ixico.com Confidential, IXICO Ltd. 2013
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
www.ixico.com Confidential, IXICO Ltd. 2013
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
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IXICO / Alzheimer’s Society focus group session
www.ixico.com Confidential, IXICO Ltd. 2013
Sample Vignettes W
ife
of
pat
ien
t d
iagn
ose
d
wit
h d
em
enti
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’
www.ixico.com Confidential, IXICO Ltd. 2013
Sample Vignettes G
ran
dd
augh
ter
of
pat
ien
t d
iagn
ose
d w
ith
dem
enti
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
www.ixico.com Confidential, IXICO Ltd. 2013
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
www.ixico.com Confidential, IXICO Ltd. 2013
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
www.ixico.com Confidential, IXICO Ltd. 2013
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
www.ixico.com Confidential, IXICO Ltd. 2013
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.”
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www.ixico.com Confidential, IXICO Ltd. 2013
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
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Alzheimer’s & Dementia 2012
Primary and secondary care dementia diagnosis NHS pilots
www.ixico.com Confidential, IXICO Ltd. 2013
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
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Current situation
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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
www.ixico.com Confidential, IXICO Ltd. 2013
‘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
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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’
www.ixico.com Confidential, IXICO Ltd. 2013
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
www.ixico.com Confidential, IXICO Ltd. 2013
Accelerating Pathways
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www.ixico.com Confidential, IXICO Ltd. 2013
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
www.ixico.com Confidential, IXICO Ltd. 2013
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
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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
www.ixico.com Confidential, IXICO Ltd. 2013
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
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Patient Report - Summary
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Patient Report
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Patient Report - Cognition
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Patient Report – Imaging
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Patient Report – Imaging
www.ixico.com Confidential, IXICO Ltd. 2013
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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www.ixico.com Confidential, IXICO Ltd. 2013
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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