The
Pharmaceutical Journal Vol 266 No 7136 p263
The use of anticholinesterases for Alzheimer’s disease in Britain |
|
By David Taylor, MRPharmS, Shubhra Mace, MRPharmS, and Charlotte Fry, MRPharmS |
|
|
In this article, the authors recount the results of a survey to evaluate the National Health Service funding and usage of anticholinesterases in British health authorities |
|
In May, 2000, we conducted a survey of the use and funding of anticholinesterases for Alzheimer’s disease. In the questionnaire, we also addressed more specific issues such as reasons for not funding anticholinesterases and conditions on the funded use of these drugs. In April 2000, we obtained the names and addresses of health authority prescribing advisers or their equivalent from the Department of Health, the Scottish Executive and the National Assembly for Wales. A total of 135 questionnaires were sent out in May, 2000, to prescribing advisers in England, Scotland and Wales. Reminder letters were sent three weeks later in June, 2000. All questionnaires were anonymous and confidential. Results We received 99 returned surveys, of which four were incomplete and not analysed. The response rate was, therefore, 95 of 135 (70.3 per cent). Funding for the use of anticholinesterases was provided by 48 per cent of the health authorities surveyed. Despite this, anticholinesterases were being prescribed on NHS prescriptions in 84 per cent of the health authorities in England, Scotland and Wales. Financial support in the absence of official funding was provided from within trust (59 per cent) and primary care group (62 per cent) budgets with some prescribing (35 per cent) for patients recruited in clinical trials. Of the 80 health authorities where anticholinesterases were prescribed, 57 per cent officially funded their use and in most cases specific conditions were outlined. Most of the funding health authorities had in place a protocol for the use of anticholinesterases (60 per cent) with nearly as many restricting the prescribing to consultants only (56 per cent). Other cited conditions for the funded use of anticholinesterases were a capped budget (27 per cent), restricted patient numbers (11 per cent), and use of a shared care agreement (11 per cent). The majority of funding health authorities (71 per cent) confined the use of anticholinesterases to secondary care. Nearly a quarter (24 per cent) sanctioned joint prescribing in primary and secondary care but rarely funded prescribing in primary care alone (4 per cent). Only 2 per cent of funding health authorities allowed unrestricted use of anticholinesterases. Funding was not provided by 50 health authorities (52 per cent) for various reasons. Anticholinesterases were deemed by nearly a third of non-funding health authorities (30 per cent) not to be cost-effective. Two percent had not yet concluded their review of these drugs and another 14 per cent were waiting for National Institute for Clinical Excellence guidelines. Two per cent admitted to a lack of funds as their reason for not supporting the use of anticholinesterases. Many of the health authorities (44 per cent), though, gave no reason. Comment Drugs for Alzheimer’s disease are widely used in the Britain, despite inconsistent funding by health authorities. Where funding is not available, many trusts and primary care groups themselves incur the cost burden of these drugs. Health authorities gave a variety of reasons for not funding anticholinesterases and set a variety of conditions for use when funding was formally made available. There was evidence of both “postcode prescribing” and “NICE blight” in the use of drugs for Alzheimer’s disease in Britain. In January, 2001, the NICE recommended that anticholinesterases be made available in the NHS and prescribed under a protocol which includes an assessment of patients’ suitability for both initiation and continuation of treatment.1 In our survey, only 28 per cent of health authorities were funding the prescribing of anticholinesterases under an agreed protocol. Thus, if health authorities are to comply with NICE guidance, more than 70 per cent will need to alter either their funding or prescribing arrangements. Our survey has revealed unacceptable discrepancies in the funding and prescribing of drugs for Alzheimer’s disease. Since NICE judgments are designed to aid such discrepancies, it will be interesting to evaluate the expected change to uniformity over the coming months. ACKNOWLEDGMENT |