Draft guidance on drugs for the treatment of Alzheimer's disease

Alzheimer's Society comments on National Institute for Clinical Excellence (Nice) draft guidance on drugs for the treatment of Alzheimer's disease.

Date: March 2005

Summary

The Alzheimer's Society believes that the draft guidance issued by the National Institute of Clinical Excellence (Nice) on drugs for Alzheimer's disease needs substantial revision. We recommend that Aricept, Exelon, Reminyl and Ebixa should be made available through the NHS as one aspect of the treatment of some people with Alzheimer's disease.

The Alzheimer's Society believes that the draft guidance is fundamentally flawed:

• Patient/carer evidence has not been given appropriate weight. Decisions have not been based on outcomes valued by people with Alzheimer's disease and their carers.
• The benefits of the drugs on quality of life for the person with dementia and their carer have not been captured.
• The model does not reflect the reality of dementia care (including the vast amount of care provided by unpaid carers).

We have set out our concerns under five main sections:

• The wrong model has been used to calculate cost-effectiveness and incorrect assumptions have been made within the model.
• Essential factors, such as quality of life and benefits to carers, have been excluded.
• There is a lack of transparency about how decisions have been made on cost-effectiveness.
• Decisions about drug treatments cannot be made on the basis of cost alone.
• There will be potentially damaging consequences for dementia care if draft guidance is not revised.

Recommendations

The Alzheimer's Society sets out six principles which new guidance needs to take into account if it is to reflect the reality of dementia care and the outcomes that people with Alzheimer's and their carers value most highly.

• Any calculation of cost-effectiveness should be based on a measure of quality of life that is appropriate for dementia.
• The benefits that the drugs bring for unpaid carers should be recognised.
• A cost-effectiveness model should ensure that accurate costs of dementia care are taken into account.
• Any model used should reflect clinical practice.
• It should be explicit how cost-effectiveness is calculated.
• Patient/carer evidence should be given greater weight.