Wednesday, April 20, 2005

U.K. National Health System may remove anti-dementia drugs from formulary

The British National Health Service's (NHS) advisory committee has recommended taking anti-dementia drugs off their formulary. This is a stunning decision in that these drugs have been shown to be effective in treating the symptoms of Alzheimer's dementia at least in the short run (6 to 9 months).

The drugs (donepezil, rivastigmine, galantamine, and memantine) do not cure Alzheimer's but do delay progression of the disease and improve cognitive function. However, the committee (known as the National Institute for Clinical Excellence or ironically, NICE) based their decision on the fact that these drugs don't delay the time from diagnosis to institutional placement.

If the senior citizen lobby is anything like that in the U.S., I seriously doubt that the politicians ultimately responsible for the decisions of the NHS will allow these recommendations to be followed. If they do, then the U.K. political milieu is definitely very different than that of the U.S.

The article I've linked also speculates that such removal from public and private healthcare formularies could occur in the U.S. as well. Again, for political reasons, such explicit rationing of interventions known to be effective (even if only marginally so) is unlikely to ever happen here.

At present, just about every decision regarding approval of drugs or any other clinical interventions by public or private third parties is based on demonstrated effectiveness. Cost is usually not seen as a parameter. Of course when two interventions perceived to be equally effective are available, the cheaper one may be selected even though it might have disadvantages (such as a less favorable side-effect profile).

For example, in the case described above, of the four drugs for treating Alzheimer's, a health plan such as Medicaid may have only the cheapest on its formulary. Few politicians or insurance company administrators would have the stomach to restrict all of them!

While rationing in the U.S. may occur in a rather hidden setting, this type of clearly stated rationing is an anathema to most Americans.


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