UK Health Secretary John Reid has acknowledged that draft guidance from the country’s clinical- and cost-effectiveness body, the National Institute for Clinical Excellence, which recommended that Eisai’s Aricept (donepezil), Novartis’ Exelon (rivastigmine) Shire Pharmaceuticals’ and Johnson & Johnson’s Reminyl (galantamine), and Lundbeck’s Ebixa (memantine) should not be routinely used in the NHS [[01/03/05b]], has met with outrage from many parties.

“We recognise the particular challenge that NICE has faced with this review and acknowledge the considerable efforts that have gone into it,” John Ried stated, adding that he had been invited to comment on the recommendations and has brought “a number of questions which the proposed guidance raises” to NICE’s attention.

He explained that he was questioning whether the institute had carried out a cost effectiveness analysis of medication compared to non-drug interventions for cognition, behaviour, activity of daily living and carer burden. In addition, he has asked if NICE would consider reassessing cost effectiveness to include a factor of carer time in the outcome.