oppose plans to end prescribing of Alzheimer drugs
by staff reporter
are opposing plans to end the prescribing of some drugs to treat
rivastigmine, galantamine, and memantine should no longer be prescribed
on the NHS to treat Alzheimer's, says new draft guidance from the
National Institute for Clinical Excellence (NICE).
the NHS prescribing watchdog for England and Wales, has retracted
previous guidance issued in 2001 and which said that these drugs
should be prescribed for Alzheimer's disease - after reviewing latest
evidence on efficacy and cost effectiveness.
The Royal College of Psychiatrists says it "strongly disagrees'
with NICE's decision that the drugs are not cost-effective.
Susan Benbow, chair of the royal college's old age psychiatry faculty
these drugs do not provide a cure, or affect the underlying disease
process, they can bring substantial benefit to many patients.
average, drugs for Alzheimer's disease delay the decline associated
with the illness by six-nine months.
is a degree of benefit which clinicians, patients and carers value.
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."
on the proposals, released last week, are being accepted until 21
March, and final guidance is expected to come into force in July
NICE assessment group says that, although donepezil, rivastigmine,
and galantamine (collectively known as anticholinesterase inhibitors)
have proved gains in cognitive and global scales compared with placebo
in people with mild to moderate Alzheimer's disease, there is "limited
and largely inconclusive" evidence on outcomes that are important
to patients and carers, such as quality of life and time to admission
to a nursing home.
considered a range of published and unpublished trials, as well
as submissions from drug manufacturers and professional and support
organisations, when developing its draft guidelines.
it said that many of the randomised controlled trials it reviewed
were of "mixed" quality.
group also suspected "selection bias, measurement bias and
attrition bias in a number of the reviewed studies."
own cost effectiveness calculations put the group of drugs beyond
the means of the NHS, it said.
it adjusted costs to take account of the benefits attributed to
these drugs NICE estimated that donepezil, rivastigmine, and galantamine
had a "cost per quality adjusted life year gained" of
£48 000, £32 000, and £38 000 respectively; the
corresponding cost for memantine was between £37 000 and £53
its proposed recommendations are adopted the NHS would make a saving
of £15m in the first year, £45m in the second, and more
than £60m in the third.
Prof Benbow said the economic models used to justify the withdrawal
of the drugs were flawed.
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," she said.
Within the fortnight NICE has also issued for a second consultation
its clinical guidelines for depression in children, and has issued
its guidelines for obsessive compulsive disorder for a first consultation.
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