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Costs to spiral after NICE Alzheimer’s decision

By Lilian Anekwe

Exclusive: Experts have warned that the decision to recommend drug treatment for patients with all stages of Alzheimer's disease could lead to spiralling referrals and costs for GP consortia.

Earlier this week NICE announced it had given the go ahead for patients with mild forms of Alzheimer's disease to be prescribed dementia drugs, lifting previous controversial restrictions on the use of drugs in patients with less severe Alzheimer's.

In its draft technology appraisal, NICE confirmed that it is extending previous recommendations for the use of three drugs – donepezil, galantamine and rivastigmine – to allow patients with mild, as well as moderate Alzheimer's disease, to receive drug treatment. The guidance also recommended the use of memantine for severe disease and for some patients with moderate disease.

Previous NICE guidance recommended GPs use assessment scales to determine the severity of disease in Alzheimer's patients, and then refer patients with moderate and severe disease to specialists for the initiation of drug treatment.

But specialists warned that once the new guidance is implemented, all patients with Alzheimer's will be referred, leaving GP consortia struggling to ‘stem the tide of referrals'.

Professor Peter Passmore, professor of geriatric medicine at Queen's University Belfast, said: ‘The national dementia strategy advocates people being referred to specialists as soon as possible. There's no clarification to set out who should be referred and who should not.'

‘If everyone with mild Alzheimer's disease is referred there will undoubtedly be implications for referrals and the costs of the service. I would suspect that this is going to provoke a discussion amongst GP consortia about how to manage services and what they can provide given their resources, and how they propose to deal with the increase in demand for services.

‘It may be that there needs to be local agreement about referral thresholds in order to stem the tide of referrals of people with mild Alzheimer's disease.'

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