Healthy Skepticism Library item: 7072

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Publication type: Journal Article

Day M.
NICE says anti-dementia drugs should be used only for moderate Alzheimer's disease.
BMJ 2006 Oct 14; 333:(7572):774
http://www.bmj.com/cgi/content/full/333/7572/774-c

Abstract:

The National Institute for Health and Clinical Excellence (NICE) confirmed its decision this week to recommend the use of cholinesterase inhibitors only for moderate Alzheimer’s disease and not for mild disease.

Andrew Dillon, chief executive of the body, which advises on the use of drugs in the NHS, said, “Alzheimer’s is a cruel and devastating illness, and we realise that today’s announcement will be disappointing to people with Alzheimer’s and those who treat and care for them.

“But we have to be honest and say that based on all the evidence, including data presented by the drug companies themselves, our experts have concluded that these drugs do not make enough of a difference for us to recommend their use for treating all stages of Alzheimer’s disease.”

More than 80 000 people with Alzheimer’s disease are expected to be denied the drugs, which have been claimed to slow or prevent memory loss.

Campaigners reacted angrily to the news. Clive Ballard, of the Alzheimer’s Society, said, “We’re astonished and appalled by this decision.” He said NICE had made “fundamental errors” and called for ministers to intervene.

“It’s now time for the Department of Health to take leadership over this farcical process and ensure people with Alzheimer’s disease get the treatment they need,” he said.

David Anderson, of the Royal College of Psychiatry, said: “This is a terrible decision based on a deeply flawed process. 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 [€3.70; $4.60] per day.”

The drugs are able to slow or occasionally halt cognitive loss caused by Alzheimer’s disease, but they are not always effective, and NICE says they are too expensive for the amount of benefit they provide.

In January NICE first ruled that people with early stage Alzheimer’s disease should effectively wait until their condition has worsened before becoming eligible for treatment. The outcry was so great that NICE finally allowed an appeal in July.

Some groups, including the Alzheimer’s Society, Age Concern, the Royal College of Nursing, and the Royal College of Psychiatrists, put forward a case for letting all patients with the disease have access to the drugs on the NHS. But this week NICE reaffirmed its original decision.

Pauline Ford, an expert on Alzheimer’s disease at the Royal College of Nursing, said, “NICE’s decision removes hope. Families can no longer have the drugs which we know make a big difference to their quality of life.”

The Liberal Democrats’ health spokeswoman, Sandra Gidley, said: “Unfortunately this decision sends the message that quality of life for older people does not matter.”

Keywords:
Alzheimer Disease/drug therapy* Cholinesterase Inhibitors/therapeutic use* Humans