Donanemab, a drug that slows the progress of Alzheimer’s disease, has been deemed too expensive for the NHS to use given its small benefits, according to the drugs spending watchdog, the National Institute of Health and Care Excellence (NICE). Last year, Donanemab was celebrated as a turning point in the disease, but the drug offered only meagre gains to patients while carrying significant risks and high costs. Monitoring for significant side-effects, including brain bleeds and brain swelling, would further impact patient care. The high price of the drug, combined with additional expenses, made it five to six times more costly than the NHS usually considers acceptable.
However, successful clinical trials have shown that Donanemab clears sticky amyloid proteins from the brain that cause Alzheimer’s. This process leads to the slowing down of the disease’s progression but, unfortunately, does not cure it. Despite receiving a licence to be used in the UK, NICE ruled that Donanemab would not represent a good use of taxpayers’ resources, providing patients only four to seven months’ cognitive decline delay in trials.
It is not known exactly how much the NHS would have spent on Donanemab, but the drug’s official price in the US is around £25,000 per year per patient. NICE’s decision is final, and it means that around 70,000 patients in England would have been eligible for treatment with Donanemab, while Wales and Northern Ireland usually follow NICE decision criteria. The decision about Donanemab followed a similar rejection for another Alzheimer’s drug, lecanemab, which was deemed too costly for the NHS during the summer.
Donanemab is not free of side-effect risk, and up to a third of patients in trials experienced brain swelling, which for most resolved without causing symptoms, but two volunteers died due to dangerous swelling in the brain. Therefore, patients must pass genetic testing before receiving the drug and undergo regular follow-up measures. Donanemab’s impact was also limited to 18 months, with the consequences beyond that remaining unknown.
Although the Alzheimer’s Society’s Prof Fiona Carragher described the decision as “disheartening,” she added that the new drug represented “a new horizon of hope in the fight against dementia,” as drugs can now slow down the disease, even if only by smaller amounts. Similarly, Prof Tara Spires-Jones, the president of the British Neuroscience Association, said people living with dementia and their families would undoubtedly be disappointed but the positive results from the trials offered hope
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