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NICE bows to pressure over Alzheimer's drugs

NICE has relented in the face of intense political pressure and granted limited access to acetyl-cholinesterase inhibitors for Alzhemier's disease.

By Daniel Cressey

But the institute's decision to allow use of donepezil, galantamine and rivastigmine for moderate disease has provoked a furious public row.Charities and some doctors have attacked the institute for denying access to patients with mild disease ­ and warned some would feign more serious illness to get treatment.

But NICE has also faced questions about its credibility and independence after it emerged its decision to approve limited use of the drugs appeared at direct odds with the conclusions of its own expert assessors.

A Health Technology Assessment, prepared for consideration by NICE and obtained by Pulse this week, rejected use of acetylcholinesterase inhibitors for mild to moderate disease. It concluded: 'The savings from reducing time in full-time care do not offset cost of treatment sufficiently to bring cost-effectiveness to levels generally considered acceptable by NHS policy makers.'

Dr Emma Loveman, lead author of the HTA and research fellow at the Southampton HTAs Centre, told Pulse: 'There are some clinical effects but when you look at cost effectiveness it's not as positive.'

Professor Alan Maynard, professor of economics at the University of York, said NICE had 'bent over backwards' to justify access to the drugs. 'You could almost say they have bent too far and erred on the side of generosity,' he said.

Andrew Dillon, chief executive of NICE, insisted a separate analysis had revealed the drugs were cost-effective for moderate Alzheimer's disease specifically.

But NICE has been under unprecedented pressure to reverse its original decision to bar access to acetylcholinesterase inhibitors after the Department of Health told it to reassess.

Professor Clive Ballard, director of research at the Alzheimer's Society, said there had been 'a lot of campaigning - an awful lot of pressure'.

But the partial reversal has not satisfied dementia experts. Dr Helen Hosker, a GPSI in old age medicine in Manchester, said: 'Patients who could benefit would be denied treatment.'

Professor Ballard added: 'It will lead to people deliberately failing memory tests.'

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