Alzheimer’s Coming of Age Moment 

A son, older in age and dressed in a red and blue collored shirt holds the hand of his ailing elderly mother with both of his own hands.
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The TD Cowen Insight

Alzheimer’s disease is at a crossroads. New drugs that slow progression become available and blood-based assays could soon ease diagnosis. The market will take time to grow as logistics and payor hurdles are eased and doctors gain comfort. We estimate total category sales for anti-amyloid drugs growing to $7B in 2028 on 14% penetration. Blood-based tests are gaining traction with assays for p-tau coming online and potentially reducing reliance on PET imaging, where we estimate a $5B+TAM that will be penetrated over time.

How Many People Are Impacted By Alzheimer’s in the U.S?

Alzheimer’s disease is a devastating condition that costs the U.S. health system $300B annually. According to the Alzheimer’s Association, there are 5.7MM Americans with clinical Alzheimer’s, 8.5MM with mild cognitive impairment (MCI) or prodromal AD, and 38MM people over the age of 30 with amyloid and therefore at risk for dementia.  

How Quickly Will New Alzheimer’s Treatments Be Adopted?

The field has been littered with clinical failures and controversies as to whether agents that target beta amyloid, a hallmark of Alzheimer’s disease pathology, can slow cognitive decline. That controversy has been quelled, by a recently approved medication. Now, attention is focused on commercial execution and clinician, patient, and caregiver uptake. 

In this report, we delve into these key controversies over the adoption curve to establish a framework and set expectations. We anticipate that logistic and payor hurdles, as well as clinician comfort with managing AIRA will guide adoption of new Alzheimer’s treatments. We expect modest growth in the initial 2-3 years (2023-2025), accelerating significantly thereafter as doctors gain experience with administering the drug(s) and managing ARIA.  

Estimating Sales for Beta Amyloid Antibodies

TD Cowen estimates that total sales in the Alzheimer’s disease category will grow significantly from ~$0.2B in 2022 to $7.0B in 2028 (a 79% CAGR) as the beta amyloid antibodies are adopted. Our estimates may be conservative, but we take into consideration the complexities of introducing new drugs into a disease state that until now has had no effective therapy. We also consider the complex side effects and logistical challenges for these new anti-amyloid drugs. We believe these complexities will take time to overcome. The availability of subQ formulations, blood-based tests (particularly for tau), and other factors could shift share or accelerate the ramp. 

Commercial Outlook for Alzheimer Disease Therapies

This multi-analyst report provides an in-depth look at the commercial outlook for disease-modifying therapies in Alzheimer’s disease over the next three to five years, as well as an overview of blood-based tools and tests. It dives deep into the logistics of supporting and delivering these new treatments and is supported by interviews with 9 KOLs and a proprietary survey of 25 neurologists. It also incorporates review of the literature and policy landscape, as well as analyses of the clinical data and pipeline for Alzheimer’s disease treatments and diagnostic tests. 

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