Tuesday, Nov 22 2005
WSJ Examines British Decision on Alzheimer's Disease Medications
The Wall Street Journal on Tuesday examined a preliminary decision issued by the British government that calls on physicians to no longer prescribe Alzheimer's disease medications because the "benefit isn't worth the cost." According to the Journal , the case highlights "one of the most disputed issues in medicine today. If a treatment helps people, should governments and private insurers pay for it without question?"
Clinical trials of Alzheimer's medications -- such Aricept, developed by Pfizer and Eisai, and Exelon, developed by Novartis -- indicate that such treatments in the short-term can delay the progression of the disease and improve cognitive function for some patients. Alzheimer's medications cost about $1,500 annually per patient in Britain for a total cost of about $100 million annually to the National Health Service.
In January 2001, the NHS National Institute for Health and Clinical Excellence concluded that the benefit of Alzheimer's medications outweighed the cost.
However, NICE this year conducted a new cost-benefit analysis of Alzheimer's medications that used a different methodology and new trial data. The analysis found that Alzheimer's medications cost more than $100,000 per "quality-adjusted life year," which means that the treatments cost $100,000 for each year they extend the life of a patient in perfect health.
NICE maintains that medications should cost no more than $50,000 per QALY. NICE announced the decision on Alzheimer's medications in March and reaffirmed the decision in June.
The decision applies only to new Alzheimer's patients and is not final.
According to the Journal , the decision "has sparked protests" from pharmaceutical companies that maintain the British government used incorrect financial data in the cost-benefit analysis of Alzheimer's medications. In addition, pharmaceutical companies maintain that NHS will spend more on nursing home care because of the decision.
More than 8,000 Alzheimer's patients and caregivers also have written NICE to protest the decision.
In response, NICE has scheduled a meeting on the decision for Dec. 20. At that point, NICE could finalize the decision, although pharmaceutical companies and patients would retain the ability to appeal.
According to the Journal , NICE does not have the authority to require physicians not to prescribe Alzheimer's medications, but, because many physicians are employees of local units of NHS, they would face budgetary "pressure" not to prescribe them (Whalen, Wall Street Journal , 11/22).