19/06/06 - Alzheimer's campaigners appeal against NHS drugs 'penny pinching'

Charities have lodged an appeal over “penny pinching” recommendations against prescribing some Alzheimer's drugs on the NHS.

The Alzheimer's Society, the Royal College of Nursing (RCN) and Age Concern will appeal a final appraisal determination from the National Institute for Health and Clinical Excellence (Nice) over the drugs Aricept, Exelon, Reminyl and Ebixa.

In May, Nice issued its final recommendations, subject to appeal, saying that Aricept (donepezil), Exelon (rivastigmine) and Reminyl (galantamine) should only be recommended for those with Alzheimer's of moderate severity.

Ebixa (memantine), which is licensed for use in the later stages of the disease, was not recommended for anyone, except in clinical trials.

All the medicines are the only drugs licensed in Britain for the treatment of the disease but Nice has said those already on them will not have them withdrawn.

The Nice guidance is due to be presented to the NHS in July but the joint appeal could now halt that process.

The groups argue that the “penny pinching” decision "is destined to return the UK to the dark age of dementia care”.

They say there was "catalogue of failures" by Nice in the way it reached its decision to deny people in the early and late stages of Alzheimer's disease access to the drugs.

They condemn the guidance as “perverse” in light of evidence showing the benefits of the drugs, which they say cost as little as £2.50 a day per patient.

Neil Hunt, chief executive of the Alzheimer's Society, said: “How can a body which prides itself on clinical excellence produce such unethical and damning guidance?

“We are left with no choice but to appeal this appalling and morally perverse decision.

“This is the beginning of our fight back on behalf of hundreds of thousands of people with Alzheimer's disease who deserve more dignity and respect.”

Pauline Ford of the RCN added: "Nurses are at the heart of the process of assessing, prescribing and delivering care to people with dementia.

“By denying them the chance to prescribe these drugs that we know will make a difference to our patients, Nice's decision will undermine the trust between nurses, patients and their families.”

Gordon Lishman, director general of Age Concern said: “It is simply cruel that Nice is proposing people are going to have to get worse before they receive help.

“It is crucial that these drugs are made available to people in the early stages of dementia.

“They can cost as little as £2.50 a day per person and can make day-to-day life more manageable for thousands.”

The Royal College of Psychiatrists is also appealing against the Nice recommendations.

In a letter to The Daily Telegraph today, Susan Benbow, Chair of Faculty of Old Age Psychiatry at the College, says the decision is “inhumane” and calls for it to be overturned.

She writes: “We (the Faculty) write to support appeals lodged today by the Alzheimer's Society, Royal College of Nursing, Age Concern, Royal College of Psychiatrists, British Geriatrics Society and Dementia Care Trust against the decision by the National Institute for Health and Clinical Excellence (Nice) to deny access to anti-dementia drugs to people in the early and late stages of Alzheimer's disease.

“Nice proposes that people in the early stages of Alzheimer's disease will have to wait until they deteriorate before allowing them access to treatments, which Nice itself admits are clinically effective, arguing that they are not cost effective. These drug treatments cost only £2.50 a day.

“The General Medical Council's “duties of a doctor" (2001) state that we must make the care of the patient our first concern, and that we must "not give or recommend to patients any investigation or treatment which (we) know is not in their best interests, nor withhold appropriate treatments”.

“Nice's decision conflicts with our duties as doctors to our patients and their families: it is unjust and inequitable.

“We are calling for this inhumane decision to be overturned.”

A spokesman for the British Geriatrics Society said Nice did not appear to have consistently applied its own rules on cost effectiveness.

He added: “Patient care should be delivered on the basis of need and as soon as possible, and drugs should not be withheld until the condition has reached a serious stage.”

Eisai Limited, the maker of Aricept, and Pfizer UK Limited, its marketing partner, said they would also lodge an appeal today.

They said they believed Nice "failed to act fairly and in accordance with its own appraisal procedure, prepared guidance which is perverse in the light of the evidence submitted, and exceeded its powers.”

Dr Paul Hooper, managing director of Eisai, said: "We are appealing against the fairness and the transparency of the processes Nice used to reach its conclusion on mild Alzheimer's disease - but mainly we are appealing against the perverse nature of that conclusion.

“In every other disease doctors are encouraged, even instructed, to find and treat patients early.

“However with Alzheimer's disease Nice is saying wait until patients deteriorate before you treat them.

“It makes no sense medically, it makes no sense economically and it makes no sense in improving the lives of patients and their carers.”

Dr Olivier Brandicourt, managing director of Pfizer UK, said: ”NICE appears to have used an arbitrary decision making process and have kept details of the model used in their cost effectiveness calculations secret.

“But aside from this, what it is proposing is contrary to all good clinical practice.”

Source : Press Association