Skip to main content

Alzheimer's Disease: Nice Guidance

Volume 670: debated on Thursday 10 March 2005

The text on this page has been created from Hansard archive content, it may contain typographical errors.

11.22 a.m.

asked Her Majesty's Government:

Why the National Institute for Clinical Excellence has reversed its January 2001 guidance and recommended withdrawal of access to medicines for Alzheimer's disease from the National Health Service.

My Lords, the draft technology appraisal issued by NICE on 1 March is a consultation document setting out its proposed guidance on drugs for the treatment of Alzheimer's disease. I understand that NICE's draft recommendations differ from those in its original 2001 appraisal because it has taken account of more recent evidence on the effectiveness of the drugs. NICE will carefully consider all consultation responses before issuing its final guidance. Until that is issued, the NHS should adhere to the recommendation of NICE's 2001 appraisal, which means that existing patients should continue with their present treatment.

My Lords, I thank the Minister for that reply, which gives me some hope. I am sure that he will agree that the true cost of withdrawing the drugs, if they were to be withdrawn, would be much greater than the direct cost to the NHS. In considering it, did NICE look at the cost to the economy of people leaving work to become carers, for example, or the cost to health and social care providers as well as families of the need for greater hospital nursing and community care services? Will the Government's response to the NICE recommendation, when it has been considered, take account of the cost in human suffering of the growing number of people for whom the drugs could give six months or even a year of prolonged independence, as well as the impact on their loved ones of a disease that we all acknowledge is absolutely dreadful?

My Lords, I am sure that the whole House will sympathise with all people who have Alzheimer's and their families. The noble Baroness is right—it is important that full and proper account is taken of the wider impact of the drugs, particularly on the carers of people with Alzheimer's disease, who are often elderly themselves. The full costs and benefits need to be taken into account. I am sure that the issue will be considered very carefully by NICE in the consultation process that is taking place, and that full information on the issues will be totally explored in that process.

My Lords, does the Minister accept that we have seven years of very good evidence that the drugs improve the quality of life of the patients and their carers, and that the only way to determine whether the drugs will benefit a patient is to try them out?

My Lords, I accept that we need evidence. That is why, in the whole area of technology appraisals, the Government established the National Institute for Clinical Excellence so that the effectiveness evidence could be fully explored and documented in the public arena, and that the data could be related to the cost in terms of quality-of-life years. In this case, I am sure that NICE will consider all the evidence, as it has done in other parts of its work.

My Lords, does my noble friend accept that, over the years that NICE has been in existence, a considerable number of new drugs that have proved very effective have been made available to NHS patients as a result of the work that it has undertaken? Does that not suggest that we should have some trust in its judgment and await the final results of its work in the area?

My Lords, my noble friend is right; I am not surprised about that given his experience. NICE has an international reputation for its work on clinical effectiveness and cost-effectiveness. Many of its pieces of guidance—there have been 88 technology appraisals, of which this is one, and 25 clinical guidelines—have produced results that have benefited thousands of patients. On record, I want to correct what has been said in the media. The recommendation is not a matter of cost. NICE has recommended many drugs with far higher costs than the Alzheimer's drugs in this study.

My Lords, what is the cost on average of treating a patient with the drugs that it is proposed be discontinued? I am clear that NICE has to assess things on the basis of value for money; on the whole, we are impressed by its efficiency. However, as my noble friend said, the trial research period of seven years is a long time to establish the effectiveness.

My Lords, we are generalising a bit in the area, but a typical annual cost per patient for this class of drugs would be about £1,000, which is relatively low compared with some other drugs. For example, the annual cost of some drugs for treatment of rheumatoid arthritis is between £8,500 and £10,500. I emphasise that the recommendation is not a matter of cost. NICE is looking at the clinical effectiveness as well. We must have some trust in its capacity to evaluate the evidence available in the area.

My Lords, how will individual patients be involved in making decisions about the use of the drugs? NICE has a patients' panel. To what extent will it be involved, especially through patients who have already found the drugs helpful and those who believe that they might?

My Lords, NICE has a tremendous record in taking account of patients' views when preparing guidance. It makes particular effort to include patients and the public in the development of all its guidance. It also operates a citizens' council, a 30-member advisory body established to consult and advise on social, moral and ethical issues relating to its work. On this health technology appraisal, NICE consulted a number of patient care groups, such as the Alzheimer's Society, Counsel and Care for the elderly, Age Concern, the Dementia Care Trust and the Mental Health Foundation. It will continue to listen to advice from all those sources during the process of consultation.