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Monday, 11 November, 2002, 02:46 GMT
Alzheimer's drugs still rationed
elderly man in wheelchair
Drugs can slow progress of the disease
One in four health authorities continue to ration Alzheimer's drugs despite guidelines saying they should be available on the NHS, a survey has found.

The National Institute for Clinical Excellence (NICE) ruled in January 2001 that three drugs should be prescribed for patients with mild and moderate forms of the disease.


With the benefit of these drugs to many people with dementia now being clear, it is a tragedy that people continue to be denied access to them

Simon Denegri
The drugs are: donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl).

However, a survey published on Monday found that only 76% of health authorities were providing formal funding for the drugs.

Nearly one in five HAs (17%) capped budgets for the drugs, and 3% restricted patient numbers who could receive them.

Problems 'will continue'

The researchers say the findings are likely to apply in equal measure to primary care trusts, which have taken over the responsibilities of HAs, as they face the same choices and funding decisions.

David Taylor, and Shubhra Mace, pharmacists at the Maudsley Hospital, London, received completed questionnaires from 63 pharmaceutical advisers at HAs in England and Wales.

The survey found that one in ten of the pharmaceutical advisers said they did not believe their HA complied with the NICE guidelines for the treatment of dementia.

Nearly a quarter (24%) said that working across organisational boundaries made it difficult to comply with the NICE guidelines.

The majority of the HAs laid down conditions on the use of the drugs.

In the main these were a reflection of the NICE guidelines, for instance that only specialists should initiate treatment, but some had added extra conditions.

Family doctors are allowed to take over prescribing the drugs where there are shared-care protocols setting out how this will work - but only half the HAs in the survey had such arrangements.

Improvement

Mr Taylor said: "Things have improved following the publication of NICE guidance.

"What is disappointing is that improvement is rather patchy.

"That some health authorities were still denying funding for these drugs is cause for concern."

The Alzheimer's Society said complaints about difficulty in obtaining the drugs had dropped in recent months - but there were still cases where people were having to fight to receive the treatment.

Simon Denegri, Assistant Chief Executive of the Society, said: "It is evident that these drugs are still being rationed in various ways; by restricting access, limiting budgets or applying narrow criteria for prescribing.

"With the benefit of these drugs to many people with dementia now being clear, it is a tragedy that people continue to be denied access to them."

The three drugs approved by NICE are known collectively at the acetylcholinesterase inhibitors.

They are not a cure fro Alzheimer's, but they can slow down the progress of symptoms of the disease.

The drugs cost around 1,000 per year. NICE estimates that the total drug bill - based on some 30,000 patients receiving these drugs - would be 42m a year.

The research is published in the Pharmaceutical Journal.

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