Magazine article Clinical Psychiatry News

U.K. Considers Pulling Four Antidementia Drugs

Magazine article Clinical Psychiatry News

U.K. Considers Pulling Four Antidementia Drugs

Article excerpt

A British proposal to remove four antidementia drugs from the National Health System formulary is unlikely to affect Medicare coverage of these agents, but some experts in the United States worry that it could influence private payers here.

The National Institute for Clinical Excellence (NICE), the independent body that recommends which medical therapies the National Health System (NHS) should provide in England and Wales, has proposed that donepezil, rivastigmine, galantamine, and memantine no longer be used to treat Alzheimer's disease.

Although acknowledging that the drugs provide moderate, short-term cognitive and behavioral benefit for some Alzheimer's patients, NICE's proposal holds that the drugs fail to delay time to institutional placement and thus are not cost effective.

The proposal appears to be a wholly economic one, according to the draft document and experts in both the United Kingdom and the United States. The drugs aren't prohibitively expensive on an individual basis--annual therapy runs about $2,000 per patient--but they cost the NHS the equivalent of $92 million in 2004.

As in the United States, the United Kingdom has projected steadily increasing Alzheimer's drug expenditures, saying spending could exceed $134 million by 2006. The total NHS 2004 budget was about $151 billion. Withdrawing the drugs from the NHS could save $29 million the first year and $115 million by the third year.

The U.K. proposal would have no effect on national policy this side of the Atlantic, said Peter Ashkenaz, spokesman for the Centers for Medicare and Medicaid Services. The federal government has already committed to offering at least two cholinesterase inhibitors as part of the Medicare Prescription Drug Improvement and Modernization Act of 2003. The new coverage will begin in January 2006. Mr. Ashkenaz did not know which two in the class would be covered.

"As long as these drugs are approved by the Food and Drug Administration for Alzheimer's, they will be covered under the new prescription drug benefit," he told this newspaper. …

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