Two new dementia drugs could be available to patients in the UK in 2024, but the NHS might struggle to make them accessible. The healthcare system could face some problems with Leqembi (lecanemab) by Eisai/Biogen and donanemab by Eli Lilly, as recent statements from NHS England, NICE, and a parliamentary information pack have suggested.
The drugs will have to get a recommendation from NICE if the MHRA approves them. The institute’s Health Technology Assessment Innovation Laboratory has looked into the main issues that could affect current and future evaluations. It is not clear how many people have mild cognitive impairment and invasive tests are still needed. There is no published data on the long-term effectiveness of Disease-Modifying Therapies ( DMDTs) , so trial data will have to be extended to estimate the lifetime benefit in terms of quality and length of life. Economic modelling will also have to consider the extra costs of intravenous infusions in hospital and any related complications or reactions, as well as the costs of monitoring for side effects.
Alzheimer’s Research UK is afraid that any new DMDT will not be cost-effective enough for NICE and might be denied. The charity hopes the NHS and manufacturers will agree on managed access agreements to handle uncertainty—possibly through the new £340mn Innovative Medicines Fund.
In 2021, about one third of psychiatrists thought their services could provide new DMDTs within a year of approval. Only 2% of people have access to lumbar punctures or PET scans now. A £5mn project aims to make blood tests for Alzheimer’s disease available on the NHS in the next five years.
The 42 integrated care boards (ICBs)—supported by #NHS England—will be the main commissioners for most of the referral and treatment pathway. The Major Conditions Strategy—which includes dementia as one of six priority disease areas—asks NHS England to map Alzheimer’s disease therapies. In summer 2023, NHS England created a national programme team for early treatments for #alzheimersdisease. It will work with local health systems, manufacturers, patient organisations, research bodies, regulators and other stakeholders to prepare the NHS for the approval of new DMDTs.
Alzheimer’s Research UK has proposed a national network of brain health clinics to support existing dementia services. NHS England and the ICBs could adopt this model if the new DMDTs are approved for use by the NHS. The charity also wants a cross-specialty Alzheimer’s Disease Clinical Pathway Council to develop new ways for the diagnosis and treatment of #dementia.