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Last Updated: Wednesday, 7 January, 2004, 01:03 GMT
Patients 'denied Alzheimer drugs'
Alzheimer's cases are expected to increase
Many people with Alzheimer's disease may be being denied access to drugs which could slow their condition, a study suggests.

Statisticians from pharmaceutical firm Pfizer found some parts of the UK spent 10 a head on drugs for the over-65s, but others spent just 1 a head.

Campaigners say patients deserve much better, and have called for action from on Health Secretary John Reid.

Alzheimer's drugs are supposed to be available across the NHS.

In England and Wales the Nice guidance has successfully moved the baselines up, but not produced equality.
Dr Roger Bullock
The National Institute for Clinical Excellence (NICE) issued guidance in January 2001 which said anti-dementia drugs were clinically and cost effective.

The Pfizer team found that overall spending on the drugs had increased sharply since 1991.

However, they also found "significant geographical variation" in their uptake.

They looked at the money spent on the three main anti-Alzheimer's drugs - donepezil, rivastigmine and galantamine - in 52 strategic health authorities and boards in the UK.

Big differences

Geographical variation from national average in AD drug sales 2002/03

The Eastern Health and Social Services Board in Northern Ireland spent 10 per head on over-65s.

But in Lothian in Scotland, where health matters are the responsibility of the Scottish Executive, the figure was less than 1 per head.

Even in areas with a similar number of people aged over 65 - those most likely to be suffering Alzheimer's - budgets for the drugs varied widely.

In Thames Valley SHA, with an over-65 population of 311,000, spending on the drugs in 2002/3 was around 485,000.

But in West Yorkshire, with 312,000 over-65s, spending on the treatments was nearly double at 879,000.

In Cheshire and Mersey, with 382,000 over-65s, 830,000 was spent on the drugs, while in Greater Manchester, with a smaller population of around 374,000 over-65s, more than 1 million was spent.

Too complex

Dr Roger Bullock, of the Kingshill Memory Research Centre in Swindon, said the NICE guidelines had "over-complicated" the provision of care.

They state that consultants have to initiate prescribing and GPs can only issue the drugs under their supervision.

He said: "In England and Wales the Nice guidance has successfully moved the baselines up, but not produced equality.

"In areas where Alzheimer's disease funding has always been a low priority, it remains at a minimal level."

Neil Hunt, chief executive of the Alzheimer's Society, said: "These drugs are not a cure but slow the worsening of symptoms and improve the quality of life for those with dementia and their carers.

"People with Alzheimer's have a progressive, degenerative condition and a six-month wait for treatment is one they cannot afford."

Our concern is for the next generation of drugs because this has taken six or seven years for the problem to be solved
Jim Jackson
Alzheimer's Scotland
Jim Jackson, chief executive of Alzheimer's Scotland, said the findings confirmed the organisation's own research, carried out last year.

"Lothian was low within Scotland but is getting better, our concern is for the next generation of drugs because this has taken six or seven years for the problem to be solved," said Mr Jackson.

A spokesman for Lothian NHS and Lothian NHS Board said it was aware of the research by Pfizer and "people may be aware that Pfizer co-market one of the drugs concerned".

He said Lothian officials had not received a copy of the report and significant reservations" remained about the findings due to the methodolgy used.

Professor Peter Donnelly, Director of Public Health and Health Policy, at NHS Lothian said: "It is encouraging that Jim Jackson, Chief Executive of Alzheimer's Scotland, has pointed to the improvement in access to services - including access to anti-dementia drugs - in the Lothian area over recent years.

"This has accelerated over the last year with the creation of the Lothian Memory Treatment Service that provides more locally based care.

"In 2003/04 this service was provided with funding in the region of 1m."

'Too severe'

A Department of Health spokesman said NICE advised that donepezil, rivastigmine and galantamine should be made available in the NHS as one component of the management of those people with mild to moderate Alzheimer's disease.

"It was not recommended as being suitable for all sufferers of Alzheimer's - for example if dementia was already too severe or patients had medical problems which ruled out using one of these drugs.

"It is not clear at this stage whether the estimates of population used in this study reflect the group of 'mild to moderate' sufferers."

"Clinicians are expected to take full account of NICE guidance.

"However, they may depart from NICE's advice if in their view the circumstances of the individual patient justify doing so."

The BBC's Wyre Davies
"A very complicated and emotive issue"

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