The Royal College of Psychiatrists strongly disagrees with
preliminary recommendations from NICE that the four drugs
(cholinesterase inhibitors) currently licensed in the UK for use in
Alzheimer's disease (donepezil, rivastigmine, galantamine and
memantine) should not be used within the NHS, as they are not cost
effective.
This advice directly contradicts previous NICE guidance in
2001, which made three of the drugs (donepezil, rivastigmine and
galantamine) widely available to patients with Alzheimer's disease
as a standard part of management within the NHS. Since that time,
many tens of thousands of patients have received, and obtained
benefit from, such medications. There have also been much wider
benefits for patients and their carers, including the expansion of
memory clinics and other services offering early diagnosis, advice
and support for people with dementia and their carers.
The College supports NICE's conclusions that there is good
evidence from clinical trials that they are effective, not only for
improving memory, but for beneficial effects on behaviour and daily
living tasks. However, economic analysis by NICE concluded that the
cost of these drugs (around £2.50 per day) put them outside the
range of cost-effectiveness that might be considered appropriate
for the NHS, given the benefits they provide.
'Whilst these drugs do not provide a cure, or affect the
underlying disease process, they can bring substantial benefit to
many patients,- stated Professor Susan Benbow, chair of the Old Age
Psychiatry Faculty.
'On average, drugs for Alzheimer's disease delay the decline
associated with the illness by 6-9 months. This is a degree of
benefit which clinicians, patients and carers value. The
prescription of these drugs has been strongly supported by consumer
groups such as the Alzheimer's Society. In our opinion, this degree
of improvement in a devastating and progressive illness for which
no other treatments are available is well worth the modest costs of
the drugs-, continued Professor Benbow.
'Alternative treatments for people with dementia would include
antipsychotic drugs for behavioural changes, a class of drugs known
to be associated with significant and serious side-effects in this
group of patients, unlike cholinesterase inhibitors which are
generally very well tolerated.-
Many patients, carers and doctors have indicated that to
obtain a 6-9 month period of stabilisation or improvement from a
progressively relentless condition is well worth the price of £1000
per year, or £2.50 per day.
Anti-dementia drugs have been licensed in the UK since 1997,
and prior to their widespread prescription throughout the NHS,
which followed directly from the previous NICE guidance in January
2001, many families were forced to fund the cost of these drugs
themselves through private prescriptions. The College is concerned
that should the draft current NICE guidance be adopted, a similar
situation would operate once again in England and Wales.
The economic models used to justify the withdrawal of these
drugs from the NHS are, in our view, flawed. They rely on using
QALY's, (Quality Adjusted Life Years), which make a variety of
unknown and untested assumptions about how quality of life relates
to dementia severity.
'These drugs are widely prescribed throughout the developed
world, including countries in Europe, the US, Canada, Australia and
New Zealand and have become more widely available in developing
nations as well,- said Professor Benbow. 'If this preliminary
guidance were to be applied, England and Wales would be the only
developed nations which did not support prescription of these drugs
within their healthcare system,- continued Professor Benbow.
'NICE suggests that only new prescriptions for anti-dementia
drugs should be affected, and that patients already receiving
treatment should be allowed to continue their therapy. This also
provides an unjust and inequitable division in healthcare
provision,- concluded Professor Benbow.
The College's Faculty of Old Age Psychiatry will be reviewing
the draft NICE guidance and will be issuing a detailed response in
the near future.
For further info on the Faculty of the Psychiatry of Old Age:
evidence to the health technology appraisal on drugs for the
treatment of Alzheimer's click the link below:
For further information, please contact Liz Fox or Deborah
Hart in the Communications Department.
Telephone: 020 7235 2351 Extensions. 6298 or 6127