New Alzheimer's drug rejected: is Nice being nasty?

"I am personally familiar with the horrors of Alzheimer's," said Catherine Pepinster in The Daily Telegraph: it's a disease my mother suffered from. So I was delighted to hear last week that the first drug found to slow down the onset of the condition had been approved for use in the UK. No sooner had this good news emerged, though, than the health watchdog Nice announced that the drug would be denied to NHS patients on cost grounds.

Trials have shown that 70,000 people in England with early-stage Alzheimer's might have been eligible for treatment with lecanemab, the drug in question, at a cost of £30,000 a year per patient – adding up to a total potential bill of some £2.1bn. Granted, that's a lot of money, but the NHS spends more than three times as much each year treating obesity. "Expensive surgeries like gastric bypasses are not withheld from the morbidly overweight. So why is a drug that could transform elderly lives neglected?"

At first glance, this may seem like "a kick in the teeth for patients", said Clare Wilson on the i news site, but Nice's decision is not driven by mere penny-pinching. For one thing, the benefits from lecanemab – which has to be administered through fortnightly infusions in hospital – are comparatively modest. The clinical trials involved giving patients complex memory tests and assessments, scoring them on a scale from nought to 18, with higher scores meaning worse memory problems. After 18 months, the scores of people receiving placebo infusions rose by an average of 1.7 points, while the scores of those on lecanemab rose by 1.2 points – not much of a difference. The drug can also cause side effects such as small brain bleeds. The money it would cost to provide lecanemab on the NHS would be better spent on treating Alzheimer's patients' symptoms, or providing sufferers with more support from social services and home nurses.

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A balance clearly has to be struck with every drug, said The Independent, but it's sad that only those who can afford to go private stand to benefit from this one. Any delay in the progression of Alzheimer's is priceless for patients – and for their families, whose interests did not feature in Nice's cost-benefit analysis. The sole consolation is that lecanemab is likely to be the first of many such drugs to appear on the market, whose costs are likely to fall over time.

In fact NHS England is currently considering 27 other Alzheimer's drugs, said Oliver Duff on the i news site: these are in advanced trials and could well be approved in the next few years. "Humanity is making progress against this appalling disease, finally unravelling the mysteries of the brain."