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Article - "NHS patients denied breakthrough Alzheimer’s drugs" (The Times - UK).

"Breakthrough drugs for Alzheimer’s will be refused for use on the NHS this week, denying the treatments to about 70,000 patients in England.
Lecanemab, made by Eisai, and donanemab, made by Eli Lilly, are the first drugs proven to slow the underlying cause of dementia, clearing toxic amyloid protein from the brain and delaying cognitive decline.
When the first positive drug trial results were announced in 2022, campaigners greeted it as “the beginning of the end” for Alzheimer’s.
Both treatments were last year given UK drugs licences, making them available privately, but the health watchdog, the National Institute for Health and Care Excellence (Nice), has repeatedly refused to recommend them for use on the NHS.
Nice is understood to be announcing its final decision this week, turning down both drugs on the grounds of cost-effectiveness. “It is the end of the road for these drugs on the NHS,” one insider said.
Hilary Evans-Newton, chief executive of Alzheimer’s Research UK, said refusal would be “deeply disappointing” and send “a damaging signal to the life sciences sector — undermining confidence in the UK as a global leader in dementia research, clinical trials and innovation, with knock-on effects for patients and the wider economy”.
She added: “These treatments are not perfect, and we recognise the challenges they pose around cost, delivery and safety. But scientific progress is incremental, and these drugs represent a vital foundation to build on.”
• UK’s most prescribed drug may reduce dementia risk by 13 per cent
Alzheimer’s affects about 600,000 of the one million people with dementia in the UK. The drugs are licensed for those in the early stages of Alzheimer’s, when they are most effective, which would have made them available to about 70,000 people in England if approved.
The treatments were shown in trials to slow the rate of decline as a result of mild to moderate Alzheimer’s by an average of about four to seven months. Some patients have reported far more dramatic results — with some even claiming it has halted their decline for years. But Nice insists the overall benefits simply do not justify the costs charged.
A year’s course of the drugs, which are administered via a drip, costs about £20,000 to £25,000, although the NHS has been offered a confidential discount on that price. The cost of scans, doctors’ appointments and the regular hospital sessions to receive an infusion means the overall price at least doubles.
In a draft document in March, Nice said: “The evidence presented so far shows neither donanemab nor lecanemab provide enough benefit to justify the substantial resources the NHS would need to commit to implement access to them.” There are also concerns about side-effects; some clinicians warn that the risk of brain bleeds are not justified by the limited benefits.
Privately, patients are charged £60,000 to £80,000 a year, according to Alzheimer’s Research UK.
Despite the cost, there is a small but growing private market for those who can afford the drugs. Eli Lilly alone said it has so far provided donanemab to about 50 private patients.
Nick Brake, 60, from Rutland in the East Midlands, was told he had Alzheimer’s last year, after a four-year battle to receive a diagnosis. He started treatment on lecanemab in February, travelling to the private Cleveland Clinic in London every fortnight to receive his infusion.
“I have no idea if it is working but you have to be positive about it and just hope it’s slowing it down,” said the father of two, who has run a series of businesses, including a café, ski chalets and a charcuterie business. “I feel much better being on it — at least we are doing something positive, rather than just sitting here thinking, ‘Oh God’.”
His wife, Nicky, 58, added: “It has been a massive boost for us. We would try anything. With all your heart, you just want everyone to have the same access.”
Dr Emer Macsweeney, chief executive of Re:Cognition Health, said she has seen a surge of interest since offering the new drugs in recent months in clinics in Bristol and London. She has even treated patients who travelled from Europe, as donanemab is not yet licensed in the EU and lecanemab received authorisation there only in April.
The US, Australia, Japan, Singapore, Taiwan, South Korea, China and several nations in the Middle East and South America have approved one or both drugs.
Macsweeney said patients who cannot afford the drugs can take part in clinical trials, which she runs on behalf of pharmaceutical clients. “The only eligibility to get onto a trial is clinical,” she added. “They are available for everybody, for free, although there is a 50 per cent chance you will be on placebo.”
Emily Pegg, medical director for Eli Lilly in the UK, said Britain would struggle to attract research and tech investment if new drugs continue to be turned down. “For us to stay competitive and become a really exceptional market that is seen as the place to come and launch a medicine, that entire [pharmaceutical] life cycle needs to function seamlessly,” she said.
“But if the patient ultimately can’t get that treatment, then fighting our corner to become one of the first markets to get an approval becomes more challenging.”

https://www.thetimes.com/uk/healthcare/article/breakthrough-alzheimers-drugs-will-not-be-available-on-the-nhs-p8xqwkj29