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Alzheimer’s drugs ‘overprescribed’ suggest NHS figures

Prescribing of dementia drugs in Alzheimer’s disease is 50% higher than expected, a new analysis of NHS data has revealed.

The analysis of data from 2012 found prescribing rates of donepezil, galantamine, rivastigmine and memantine were 50% higher than expected when compared with prevalence rates of Alzheimer’s disease.

The analysis takes into account the recommendation by NICE in 2011 that patients with mild forms of Alzheimer’s disease be prescribed dementia drugs, lifting previous controversial restrictions on the use of drugs in patients with less severe Alzheimer’s.

Experts say that the discrepancy may be because of rising prevalence rates, and an underestimation by analysts of the number of people with Alzheimer’s disease.

The data come amid the Government’s drive to increase diagnosis rates for dementia, based on figures that show a variation in the expected rates of dementia versus those identified.

The data published this week as part of an analysis of the use of NICE-approved medicines by the Health and Social Care Information Centre (HSCIC) look at the ratio between expected use and observed use of medicines in the NHS.

The most ‘over-used’ medicines were donepezil, galantamine, rivastigmine and memantine with a ratio of 1.48.

The analysis showed the proportion of patients with mild Alzheimer’s disease taking cholinesterase inhibitors was 92.7%. The proportion treated with donepezil was 68.7%, the proportion treated with galantamine was 20.1% and the proportion treated with rivastigmine was 11.2%.

In moderate Alzheimer’s disease, the proportion of people treated with memantine was 21.6%, the proportion treated with cholinesterase inhibitors was 78.4%, the proportion treated with donepezil was 68.7%, the proportion treated with galantamine was 20.1% and the proportion treated with rivastigmine was 11.2%.

In severe Alzheimer´s disease, the proportion of people treated with memantine was 31%.

Professor Steve Iliffe, a GP and professor of primary care for older people at University College London, said the study was based on old estimates of dementia prevalence.

He said: ‘The authors of the report have used Alzheimer’s Society estimates from six years ago, and the situation is different now. My guess is that two-thirds to three-quarters of people with Alzheimer’s disease are known, and that under-diagnosis occurs more often with vascular dementia.

‘Then there is the tendency to describe some people with dementia as “mixed type” with Alzheimer’s features, and of course some individuals with apparent Lewy body dementia also receive cholinesterase inhibitors.’

The HSCIC report states there are ‘difficulties in producing robust estimates of expected numbers of patients at a sub-national level.’

It also says: ‘In interpreting these figures it is important to note that predicted and observed use may differ for a variety of reasons and they should not be assumed to definitely indicate either ‘under’ or ‘over’ prescribing. Clinical judgement, changes in prevalence or incidence, the time taken for the population to present to services to enable changes in prescribing, and demographic differences across healthcare economies are potential explanations for variations in results.’

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Readers' comments (11)

  • Surely we need to start by being far more careful in our use of definitions.

    Acetylcholinesterase inhibitors and memantine are licensed for treatment of DEMENTIA of an Alzheimer's type. (BNF)

    Everywhere it seems (and indeed in this report), and even within NICE and SIGN Guidelines on dementia, one finds interchangeable use of "Alzheimer's disease" with the clinical syndrome of dementia.

    It is disappointing to find that even our experts in this area are adding to a cultural confusion that surely risks re-branding dementia as "Alzheimers".

    Further reading:
    (1) Confusion is everywhere: http://www.bmj.com/content/346/bmj.f511

    (2) Dementia Guidelines: research and clinical criteria are not simply “interchangeable”
    http://www.bmj.com/content/347/bmj.f7282/rr/676567

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  • Vinci Ho

    Oh dear
    I bet agent Hunt doesn't know and of course understand any of these. One word- confusing.......

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  • Does anyone know how much the pharma companies that manufacture these drugs contribute to the sleazy Tory party that forced through the dementia DES?

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  • This also demonstrates another problem with care.data. Information about diagnoses, read codes and prescribing/ referrals etc can be extracted at will. This information can therefore be used by those who want to micromanage and criticize what GPs do, even though it is recognised that the data is imperfect.
    Beware, every single aspect of your work is being analysed by someone.

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  • I am writing a short piece on this finding that prescribing of dementia drugs in Alzheimer’s disease is 50% higher than expected and will post a link to it here.

    My article will be called "Wandering, wondering and worrying" .. all will be revealed why I have chosen these three words in my title on prescribing for "Alzheimer's"

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  • Vinci Ho

    On this matter, please pay attention to today's BBC health news about what D. Haslam , chair of NICE , said on patients should be pushier to make GPs prescribe more drugs approved by NICE
    We need a proper debate on this subject , editor.

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  • Vinci Ho

    Haslam's interview was on Telegraph,
    '........In an interview with The Telegraph, he said: “When products have been approved for use by the NHS by Nice, patients have a legal right to those drugs - as long as they are clinically appropriate. The take-up should be much higher than it currently is."........

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  • Vinci Ho

    The former GP said: “The fundamental point is it’s your body - and the more you understand about the drugs you are taking, or what you might be able to have, the better you are able to work with your doctor.”

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  • Vinci Ho

    He said: “Americans tended to want to know more about their treatment than the British who tend to be much more ‘thank you doctor, I will take that’.”

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  • If they're not careful the British public will indeed end up with a system similar to the American one. Still, as Doctors we'll be better off...

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