October 12, 2006

experts react to NICE decision on Alzheimer’s therapy

The National Institute for Health and Clinical Excellence (NICE) has taken a decision to reject an appeal for more drugs to be made available on the NHS for the treatment of the symptoms of Alzheimer’s disease.

Dr Andrew Walker, Health Economist, Robertson Centre for Biostatistics, said:

“Value-for-money is about setting the benefits to patients against the cost to the NHS. In terms of the big picture of NHS spending this is probably the right decision but way too late: the medicines have been available for nearly 10 years. The key thing for carers and patients now will be that money saved is spent on other areas of dementia care rather than being swallowed up by NHS financial deficits.”

Prof Raymond MacAllister, Professor of Clinical Pharmacology, UCL, said:

“I agree with this decision by NICE. The problem with these drugs is that they have a very small effect in patients with advanced dementia which is of uncertain value. At present, I would rather see resources allocated to the provision of better services for patients with dementia.”

Dr David Anderson, Chair Faculty of Old Age Psychiatry, The Royal College of Psychiatrists, said:

“This is a terrible decision based on a deeply flawed process. I am astonished that the appeals against this guidance have been disregarded. Implementation of this guidance will set the treatment of Alzheimer’s disease back 10 years while the number of sufferers continues to increase rapidly. It is extremely short sighted to deny these people access to effective treatment.

“As a nation we should be ashamed that the quality of life of a person with such a serious medical condition is valued at less than £2.50 per day.”

Dr Anthony Pelosi, Consultant Psychiatrist, Hairmyres Hospital, said:

“NICE has had a very difficult task in deciding how cholinesterase inhibitors should be used in the National Health Service. This is because the scientific research does not provide adequate answers to vital questions. We still do not know, about 10 years after they became available, whether these medicines are effective enough to justify their use in Alzheimer’s disease at mild, moderate and severe stages. Do they improve most patients’ overall quality of life? What about their effects on quality of life of the relatives? Do the tablets slow down the time until nursing home care is required? We do not really know the answers to these questions. The health economic analyses that have been carried out both by NICE and by pharmaceutical companies contain too many assumptions to provide reliable estimates of the cost effectiveness of these medicines.

“There are lessons to be learned. When any new and expensive medicines are introduced there must be adequate, independent research carried out on their benefits to patients.”