ROYAL COLLEGE OF PSYCHIATRISTS' RESPONSE TO THE PROPOSAL FROM THE NATIONAL
INSTITUTE FOR CLINICAL EXCELLENCE (NICE) TO WITHDRAW TREATMENTS FOR
ALZHEIMER'S DISEASE FROM THE NHS

COLLEGE STRONGLY DISAGREES WITH PRELIMINARY RECOMMENDATIONS

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 information on this issue, you can contact:
Professor Susan Benbow on tel: 01902 575151; 
Professor John O'Brien on tel: 0191 256 3323; 
Dr Roger Bullock on tel: 01793 437501; 
Dr David Wilkinson on tel: 023 8047 5216; 
Dr Carmelo Aquilina on tel: 020 8665 6469; 
Dr Andy Barker on tel: 01425 623802; 
Professor Sube Bannerjee on tel: 020 7848 1020.
Professor Dave Jolley (Dementia Plus) on tel 01902 575056; 
Professor Gordon Wilcock on tel 0117 975 3948

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 here:

http://www.rcpsych.ac.uk/college/faculty/oap/members/index.htm
<http://www.rcpsych.ac.uk/college/faculty/oap/members/index.htm>
    

(3/3/05)