BREAKING: The NHS should not use new Alzheimer's drugs says NICE arguing the benefits are "just too small". But the drugs have been approved as safe by MHRAgovuk. Around 70,000 adults would be eligible.
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[1/2] 70,000 might be eligible but that’s after an overhaul of the diagnostic processes in place. This includes setting up clinics that would allow for gene testing and lumbar punctures (the latter carrying its own risks and an inpatient procedure ATM).
[2/2] drugs of a similar design to lecanemab are definitely up there as the drugs that carry the highest cost to the NHS. And this treatment appears to have been recommended as a fortnightly administration for an indeterminate length of time. People want a magic dementia bullet, this isn’t it.
Do NICE take into account possible increased lifetime social care costs without the drug, or doesn’t this count as service users rather than the Government pay?
Safe is not the same as cost effective. NICE used to calculate DFLYs, years of life free of disability per £. So if its a choice between 2 treatments, say new drug for AD versus one for obesity, choose the one that gives more DFLYS. Not sure this is still true.
This is a good piece about these drugs. I 💯 understand why people are so angry about the decision, believe me, but that doesn't make it a BAD decision. Everyone wants a dementia blockbuster. But it's proved to be a horribly tough problem.
Dementias cause unquantifiable human misery, and very quantifiable social care costs. And they affect people in wealthy countries. They aren't orphan diseases; there's a lot of research into a cure because it would be a literal licence to print money. Would make Ozempic look like ivermectin.
One of the drugs just approved in the US has a 30% mortality rate, which a very expensive gene test will tell you is more likely to happen. And only $2k/dose needed twice a month. But if you're in the 30% it helps, you can reverse damage. (The rest have no effect from the drug)
The cost seems about the same as care costs, possibly less, even including the follow ups. Ah perhaps pharma don't want NHS to help doing the follow up assessments gathering data on side effects might not be "worth it" for them either.
Safety is a separate issue when we work in a resource limited structure such as the publicly funded NHS - after knowing that something is safe, we also need to say how effective it will be & whether the cost is justified.
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Oh well, another time.