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United Kingdom

Reimbursement of anti-dementia drugs

The availability of medicines in general

Free prescriptions are generally available to children under the age of 16 (25 in Wales), people aged 16 to 19 but still in full education (England and Scotland only), people over the age of 60, pregnant women and women who have given birth in the last 12 months as well as people and their partners receiving income support.

Nevertheless, since primary care trusts have budgetary control over health care expenditure in their area, this entitles them to make decisions on which medicines will be available to patients free of charge in their area. It is therefore not always possible to provide general information as to which medicines are free of charge to patients throughout the United Kingdom. For some treatments, the National Institute for Health and Clinical Excellence may provide guidance documents which are widely followed by primary care trusts throughout the United Kingdom.

Under the devolved government arrangements for Scotland, NHS Quality Improvement Scotland does not reassess the evidence used in NICE guidance documents, but only seeks to identify contextual differences between England/Wales and Scotland. Hence NICE recommendations if approved for England and Wales are often also implemented in Scotland.

The availability of Alzheimer treatments

All anti-dementia drugs are available in the United Kingdom and individual health care trusts may make them available to patients free of charge.

In its guidance of January 2001, the National Institute for Health and Clinical Excellence (NICE) made recommendations for the use of donepezil, rivastigmine and galantamine and recommended that they be made available under the National Health System under certain conditions:

  • A diagnosis of Alzheimer’s disease should be done in specialist centres and NICE provides a list of examinations that should be carried out,
  • Treatment initiation should be recommended by specialist doctors only and treatment continuation decisions should only be done by general practitioners under shared care protocols,
  • NICE does not recommend the use of acetylcholinesterase inhibitors for people with an MMSE score inferior to 12.

As for memantine, the Scottish Medicines Consortium rejected the wider use of memantine through the NHS in Scotland. The NICE recommendations were published before memantine became available in the United Kingdom and the recommendations do therefore not cover this product.

The review of these guidelines was still in process as this publication went to press. [1]

United Kingdom [2]

Donepezil

Rivastigmine

Galantamine

Memantine

NICE reimbursement recommendation

Yes

Yes

Yes

No

Initial treatment decision

Specialist doctors

Specialist doctors

Specialist doctors

N/A

Continuing treatment decision

Specialists or GPs under shared care protocols

Specialists or GPs under shared care protocols

Specialists or GPs under shared care protocols

N/A

Required examinations

Diagnostic protocol

Diagnostic protocol

Diagnostic protocol

N/A

MMSE limits

Over 12

Over 12

Over 12

N/A

People living alone

No restrictions

No restrictions

No restrictions

N/A

People in nursing homes

No restrictions

No restrictions

No restrictions

No restrictions

[1] Please refer to the position of Alzheimer Europe on the availability of anti-dementia drugs in this publication for further information on this review process.

[2] The information contained in this table is based on the guidance document of the National Institute for Health and Clinical Excellence. Individual primary care trusts may have different rules in place to the ones in this table.

 

 
 

Last Updated: mercredi 15 juillet 2009

 

 
 

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