At a glance: NICE makes second U-turn on Alzheimer's

A second U-turn? Last year NICE decided to reverse a 2001 recommendation that made anti-Alzheimer’s drugs available on the NHS (PRWeek, 11 March 2005) – the first U-turn. But it has this week overturned that decision, by saying that some of them can now be offered for certain sufferers – U-turn number two.

Remind me of the drugs in question?
Pfizer/Eisai's Aricept (PR for which is handled by Clew Communications), Exelon by Novartis (The Workhouse) and Shire's Reminyl (GCI Healthcare) are all licensed for
the treatment of mild to moderate cases of Alzheimer's. Lundbeck's Ebixa (PR handled in-house) is for patients with a moderate to severe case of the disease.

And what has NICE said this time?
Ebixa won't be made available on the NHS at all because there is 'insufficient evidence' on its clinical benefit for patients. However, the first three will be used to treat people with moderate Alzheimer's.

Not mild Alzheimer's? So sufferers have to get worse?
That's the obvious PR line, of course. NICE says that since the drugs do not halt a patient's mental decline, the likelihood of benefit is greater in the moderate stage of the illness. But the Action on Alzheimer's Drugs Alliance (an umbrella group including charities and manufacturers) sees it a different way. 'For what other condition would you wait until people decline so much that they can no longer look after themselves before giving them treatment?' a spokesman was quoted as saying this week.

So who has got it right in PR terms?
Even-handed observers might think NICE has been guilty of giving out mixed messages in the past ten months, although NICE says it is merely acting on additional evidence. Drug companies (at least for Aricept, Exelon and Reminyl) will attempt to expose flaws in NICE's economic thinking and push the line that NICE has accepted that the products work but is now quibbling over when to start using them.

What happens next? Is there time for any more U-turns?
There is now a consultation on this NICE document, which ends in three weeks' time. A committee will then produce another draft, against which stakeholders can appeal. Final guidance is expected in July.

Further information
www.nice.org.uk

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