India's Alzheimer's burden is growing, but treatment still out of reach

India is gradually ageing and the risk of Alzheimer’s disease affecting more of its elderly population is on the rise. So far, the treatment offered is focused on trying to improve the patient’s quality of life, but nothing really slows down or arrests the disease. The steep prices of new therapies discovered overseas also don’t make these easily accessible for people in Indian.

A new experimental drug has, however, brought hope for patients of Alzheimer’s, which is a progressive neurologic disorder that causes the brain to shrink and the brain cells to die. US giant Biogen and Japanese Eisai’s investigational drug, lecanemab, reduced the pace of cognitive decline in people in the early stage of the disease by 27 per cent over an 18-months, the drug firms claimed last week while announcing data from a large-scale trial. Though the benefits came with side-effects like brain swelling, and even bleeding, the news caused the share prices of these two companies to rise. The findings are significant since around 22 per cent of the global population would be 60-plus by 2050.

The results support the so-called amyloid hypothesis – a long held but debated theory that claims a toxic protein called amyloid, which accumulates in the brain, is one of the main causes of Alzheimer's. Lecanemab selectively binds and neutralises the toxic beta amyloid aggregates.

What is encouraging for patients is that there are more anti-amyloid drugs in development – drugs from Roche and Eli Lilly, for example, are in the final stages of development.

These new drugs, however, are priced beyond the reach of most patients, especially in a country like India where people often pay out of their pockets for treatment.

Sample this: Biogen’s Alzheimer’s drug, Aduhelm, launched last year was priced $56000 per year, something that had irked even lawmakers in the US. In January this year, the company halved the drug’s prices to $28,000 per year, or around Rs 22 lakh per patient in Indian currencies.

“Biogen’s Aduhelm was priced around Rs 40 lakh when launched. These are mostly OPD treatments, and very few families have the kind of insurance covers to take care of such expenses,” says Praveen Gupta, principal director and head, Department of Neurology, Fortis Memorial Research Institute, Gurugram. He adds that when the incremental benefits are not much, such drugs are unlikely to gain acceptance.

But Alzheimer’s cases are rising in India. The disease is considered to be the most common cause of dementia –  a continuous decline in thinking, behavioural and social skills, which affects a person's ability to function independently.

P P Ashok, consultant neurologist and head, Division of Neurology, P D Hinduja Hospital & MRC, Mahim (Mumbai), gives some broad statistics: “For every 1,000 people aged between 65 and 74, we typically find four new cases of Alzheimer’s, and this increases with every decade. So, for 1,000 people aged 75 to 84, there are around 32 people with Alzheimer’s. For 85-plus, this number rises significantly to 76 per 1,000.”

India is still largely a young country, and so it doesn’t feel the burden of diseases like Alzheimer’s the way the West does, which has an older population, he says, adding that lack of awareness and detection also contribute to many cases going undiagnosed.

“About 30 years back, we used to say there are hardly any cases of aneurysms (an abnormal bulge or ballooning in the wall of a blood vessel) in India. But now we know how common it is,” Ashok says.

Doctors say there is no national-level policy programme for Alzheimer’s and the bulk of the family expenditure on health is on people in their productive ages. “The West has care programmes and centres that help such patients. In India, we are still largely dependent on the joint family system,” Ashok says.

Greying India

• Senior citizens will account for around 20% of India’s population by 2050, with almost one in five people aged 60 or above (UN projections)
• Around 3.7% of senior citizens suffer from dementia (6.1 mn); this number is expected to triple by 2050
• Around 20 million elderly people live alone in the country today, says Jasrita Dhir, head-Marketing & Communications, Antara Senior Care