Alzheimer's Research Trust

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For further information and to receive the full details, please email the Trust with your address on azt@btinternet.com or telephone on 01223 843899.

COMMENTARY ON NICE REPORT

NICE decision on Alzheimer’s Drugs may appease suffering for patients and relatives, but experts say further research into treatments and cost implications is still needed

The National Institute for Clinical Excellence (NICE), has approved the use of three drugs (donezepil = aricept, rivastigmine = exelon and galantamine = reminyl), to treat mild to moderate Alzheimer’s Disease, in a decision which will cost the NHS an estimated £42 million in drug costs. But although this is likely to come as a welcome relief to the families of the 500,000 people with Alzheimer’s Disease, ending months of speculation about the ruling, researchers are adamant that further research into the treatments is still necessary.

NICE are allowing treatment under guidelines which include assessment at two to four months after commencement of the drugs, and drug treatment will be halted if assessment shows no improvement or a deterioration. While the evidence submitted to NICE showed that the drugs can significantly improve symptoms in people with Alzheimer’s Disease, it is still unclear how this abatement will impact on the level of care needed by people with the disease, and questions are also being raised about how prescribing will be initiated at a local level. 

Dr Clive Ballard, a spokesperson for the Alzheimer’s Research Trust, who advised the NICE Appraisal Committee commented: “The NICE Appraisal Determination opens the door for these treatments to be provided on the NHS, and we have seen evidence that these treatments lead to significant benefits for many people with Alzheimer’s Disease. There is an average improvement of 1 to 2 points on the mini-mental state examination (MMSE) (out of a total of 30 points), though some people experience much greater improvements. Clinical audit studies have shown huge benefits for individual patients, with improvements in confidence, energy levels, and reductions in anxiety and apathy. 

There is currently no way of knowing which patients are likely to benefit from treatments, and the NICE recommendations for assessing patients’ response reflects good clinical practice. Of course, this will involve additional specialist time, and this will have resource implications. There is currently no way of knowing whether all specialist centres have the resources to do this assessment, and there may be a delay while hospitals gear up their service provision to account for this. At a scientific level, there is a clear need for further work to determine whether these drugs merely provide relief from the symptoms, or will actually alter the course of the disease and whether they are effective in dementias other than Alzheimer’s disease.”

The total drug cost is estimated to be in the region of £42 million per year, according to NICE. According to the Alzheimer’s Research Trust (ART), a charity which funds research into the disease, these costs should be more than offset by the reduction in care needed by people with Alzheimer’s Disease. 

Speaking on behalf of the ART, Professor Martin Knapp, Health economist from the Institute of Psychiatry in London, commented: “Recent surveys of residential nursing home care lead to estimate the current cost of long-term residential and nursing home care for Alzheimer’s patients is over £2 billion per year, which is based on 150,000 people being in care at any one time. Working on the assumption that the drug treatment will produce a delay of 3 months of entering into care for all those who are receiving treatment, there will be a cost saving of around £50 million, and if the delay is 6 months, the saving would be in the region of £100 million. Clearly, this will need to be weighted against any costs related to assessment of patients undergoing treatment.” 

Rebecca Wood, Chief Executive of the Alzheimer’s Research Trust, commented: “The Alzheimer’s Research Trust warmly welcomes this decision from NICE. Our own representation to NICE demonstrated the huge cost of care1 - which is double that of cancer or heart disease, and we feel that NICE has considered all the evidence presented and come to a fair and sensible decision. The guidelines allow proper monitoring and therefore will be able to show the cost and humane benefits which we firmly believe will be demonstrated by long-term studies allowing all suitable patients access to treatment. This is excellent news for patients, carers, and those doing research.” - ends -

For further information and to receive the full details, please email the Trust with your address on azt@btinternet.com or telephone on 01223 843899.

1. Cost of Alzheimer’s Disease and Level of Research Funding, a report prepared for the Alzheimer’s Research Trust by Professor Martin Knapp at the Centre for the Economics of Mental Health, Institute of Psychiatry, Kings College London. Copies of the report are available on request and the majority of it is on this website.

Download the NICE Article