Thursday, April 21, 2005

U.K. Proposal on Alzheimer Drugs - Removal From Formulary

Internal Medicine News has this story about Alzheimer Drug rationing in the United Kingdom:

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. Although the drugs aren't prohibitively expensive on an individual basis—annual therapy runs about $2,000 per patient—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 document said.

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.

But should the proposal pass, some U.S. dementia experts are concerned about spillover into the policies of private payers and managed care systems. “Insurance companies worldwide are always looking to minimize their expenses,” said Samuel Gandy, M.D., professor of psychiatry, neurology, and gerontology at Philadelphia University and director of the Farber Institute for Neurosciences, Philadelphia. “I would predict that the U.S. insurance companies are watching this very closely.”

This country's private health care system is a “patchwork” of different companies that make decisions based on both economic and clinical factors, Lon S. Schneider, M.D., said in an interview. A national dictum condemning a class of drugs as not cost effective will get plenty of notice, he predicted.

“Private payers are really this country's prescription benefits managers, and they are constantly assessing whether the drugs on their formularies are working and are cost effective,” said Dr. Schneider, professor of psychiatry, neurology, and gerontology at the University of Southern California, Los Angeles. “They are very interested in the NICE decision and analyses, which may have implications into how these companies manage their pharmacies.”

If the recommendation is accepted, no new prescriptions for antidementia drugs will be written through the NHS, although the drugs will not be withdrawn from patients already taking them.

Physicians, advocacy groups, and families in the United Kingdom have bitterly criticized the proposal, announced on March 1. Protesters contend that the drugs' true value can't be measured by a single outcome and have complained that the public comment period of only 3 weeks was far too short. They also said the decision would contribute to health care disparity in the country, since patients could still obtain the drugs through a full-price private prescription.

Britain's health minister, Stephen Ladyman, said his department will ask NICE to reconsider its cost analysis, taking into account the economic and social benefits the drugs provide to caregivers, as well as to patients. But the minister also said he wouldn't interfere with NICE's decision-making process.

NICE is expected to render its final recommendation in July.
Damn! And the U.K calls itself a civilized society?

How could you possibly equate the rationing of Alzheimer's disease care with cost?

I suggest that Tony Blair and his Labour Party get off their arses, privitize a few industries and use the resulting mega-increase in tax revenues to support their own citizens.


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