The good news and the bad came almost simultaneously. No sooner had the first drug found to slow down the onset of Alzheimer’s been approved for use in the UK than the National Institute for Health and Care Excellence (Nice), the health regulator, said it cannot be offered on the NHS.
This came as a crushing disappointment to sufferers of the disease and to charities campaigning for improved treatment. They said Nice should take into account the wider costs of looking after Alzheimer’s sufferers when making a cost-benefit analysis of the drug.
These are difficult issues that encompass more than financial considerations and go to the heart of the way the NHS is structured and funded. A health service financed almost entirely out of taxes cannot accept every new drug irregardless of cost.
The basic price of the new treatment, known as lecanemab or Leqembi, is around £20,000 in the US, but there are other costs associated with regular monitoring requirements and infusions that could push this up much further. Around 70,000 people might have been eligible for this treatment, but with the NHS facing record backlogs of treatments and with A&E in almost perpetual crisis the case for such expenditure is hard to make.
Just as many, if not more, will argue that the hip replacement or cataract operation they have been waiting for often for months or even years should take precedence.
There are also questions about the nature of the breakthrough itself. The drug slows the early progression of Alzheimer’s (though not of other forms of dementia), but there are side effects that some say are as bad as the disease itself.
Might things be different were the health system not nationalised and social insurance models of the sort commonplace in Europe operated here? Without a proper rethink about the structure of the system we will never know.
However, the likelihood must be that private insurers in the UK will not pay for this drug either. Many better off people will find the money from their savings to relieve the dreadful symptoms of Alzheimer’s.
But the development of lecanemab at least shows that what was thought to be an incurable disease may yet be tackled by medical advances. It is remarkable that science is now delivering licensed treatments that can arrest the devastating effects of Alzheimer’s, not just alleviate its symptoms.