Nice ordered to rewrite Alzheimer’s guidelines

The National Institute for Health and Clinical Excellence (Nice) has been ordered to change the way it assesses Alzheimer’s patients, in the first judicial review of its decisions.

However, the High Court today upheld Nice’s decision that Alzheimer’s drugs did not offer value for money and to restrict them to people in the latter-stages of the disease.

Alzheimer’s campaigners had wanted Nice to fund the treatment, provided by drugs firm Eisai, for people in the early stages of dementia.

Costing £2.50 per patient a day, Nice ruled the drugs did not deliver a comparable improvement to the patient’s quality of life.

The High Court today rejected the claim, brought by Eisai with support from drug firms Pfizer and Shire, that Nice underestimated the impact the drugs had.

The judge also threw out claims Nice had underestimated the cost of long-term care.

But, the High Court agreed with campaigners that the tests used to assess Alzheimer’s discriminated against people with learning difficulties or who did not speak English as their first language.

Nice has been ordered to rewrite its guidance on how the disease is assessed, but the Liberal Democrats said it was time Nice reviewed its entire processes.

Lib Dem health spokesman Norman Lamb said today’s decision was a landmark ruling of fundamental importance.

Mr Lamb said: “The ruling represents a serious challenge to Nice’s processes. Nice must now take a serious look at how it reaches these critical decisions that affect so many people’s lives.

“The health secretary needs to have urgent discussions with Nice to ensure that lessons are learnt from this debacle, which has caused so much distress to sufferers and their families.”

He warned the NHS against underestimating the positive impact of these drugs.

Mervyn Kohlder, Help the Aged special adviser, said: “Only earlier this week, the care minister was talking about ‘bringing dementia out of the shadows’: One of the shadows into which it had been cast was the Nice guidance on various drug treatments.

“It is important that Nice examines its guidance on these drugs, not just in the light of the ruling today but bearing in mind the public concern which the case has demonstrated.”

The Alzheimer’s Society and drugs firms are planning to launch an appeal, arguing the drugs should be available to those with the early stages of the disease.

In 2001, Nice recommended the drugs were prescribed as standard, but in November 2006 it changed its guidance to restrict treatment to patients with moderate-stage disease.

Andrew Dillon, chief executive of Nice said today: “Our guidance stands and the drugs continue to be recommended only for people with moderate Alzheimer’s disease, but the court has asked us to clarify our guidance when it is used for certain groups.

“Alzheimer’s disease is a devastating illness, but the evidence indicates that these drugs are simply not effective for some patients.”