Scottish Parliament Update October/November 06

PARLIAMENTARY QUESTIONS

Aricept - Donald Gorrie (LD – Central Scotland) asked the Executive what the position is in Scotland regarding the prescription of Aricept to treat people with Alzheimer’s disease. Minister for Health and Community Care (Andy Kerr) Aricept will continue to be recommended for treatment by the NHS for patients who have moderate to moderately severe Alzheimer’s disease.

Reminyl - Dr Elaine Murray (Lab – Dumfries) asked the Executive whether Reminyl will continue to be available under the NHS in Scotland as a treatment for patients with Alzheimer’s disease. Andy Kerr Reminyl will continue to be recommended for treatment by the NHS for patients who have moderate to moderately severe Alzheimer’s disease.

Cost of drug treatments for mild Alzheimer’s disease - Euan Robson (LD – Roxburgh and Berwickshire) asked the Executive what the additional cost to the NHS would be if donepezil, galantamine and rivastigimine were prescribed to people with mild Alzheimer’s disease. Deputy Minister for Health and Community Care (Lewis Macdonald) guidance issues by NICE in 2001, and endorsed by the then Health Technology Board for Scotland, recommended the use of donepezil, galantamine and rivastigmine for patients with mild to moderate dementia in Alzheimer’s disease. In 2005-06, prescribing data on drugs dispensed in the community showed that Ł7,470,042 was spent on the three drugs. Hospital prescribing data is not included. This cost includes the prescribing of the drugs to patients in the mild stage of the disease. It is not possible to identify from prescribing data the cost attributable to patients with the mild form of the disease. The prescription form does not specify whether the drug is prescribed for a patient with mild or moderate disease. In addition, the cost vary depending on the drug prescribed and the required daily dose prescribed for each individual patient.

NICE appraisal - Euan Robson asked the Executive what account has been taken of any savings to the NHS and local authorities in social care costs as a result of people being able to lead independent lives for longer if donepezil, galantamine and rivastigmine were to be prescribed to those with mild Alzheimer’s disease. Lewis Macdonald NICE process for developing its multiple technology appraisals takes factors such as wider benefits to patients families and society into account when it is appropriate to do so. NICE economic modelling on its work for the appraisal of donepezil, galantamine and rivastigmine included an assessment of the impact of benefits accruing to carers. The NICE process also assessed the impact of alternative cost estimates (including a scenario in which 100% of the costs of institutional care was met by the NHS), extra benefits from using the drugs and sensitivity analysis on mortality and behavioural symptoms.

Private prescriptions for drug treatments - Euan Robson asked the Executive whether it will monitor the number of patients who choose to purchase donepezil, galantamine and rivatigmine privately for mild Alzheimer’s disease. Lewis Macdonald information on private prescriptions is not collected centrally except for schedule 2 and 3 controlled drugs.

Private prescriptions for drug treatments - Euan Robson asked the Executive whether it will undertake a study to compare the outcomes for patients who purchase donepezil, galantamine and rivastigmine privately for mild Alzheimer’s disease and patients who do not receive the drug until they develop moderate Alzheimer’s disease. Lewis Macdonald the Chief Scientist Office (CSO) within the Scottish Executive Health Department has responsibility for encouraging and supporting research into health and health care needs in Scotland. The CSO does not normally commission research but supports research projects of a sufficiently high standard initiated by the research community in Scotland. This role is well known and advertised throughout the health care and academic community in Scotland. Although the CSO is not directly funding any research into anticholinesterase inhibitors donepezil, galantamine or rivastigmine, it would be pleased to consider proposals for research into Alzheimer’s disease which would be subject to the usual peer and committee review. The Medical Research Council, one of the main agencies through which the UK Government supports medical and clinical research, currently supports two trials looking at the efficacy of anticholinesterase inhibitors in the treatment of patient groups with moderate to severe Alzheimer’s disease.

PARLIAMENTARY MOTIONS

Treatment of Alzheimer’s patients – Donald Gorrie (LD – Central Scotland) the Parliament would welcome the opportunity to take part in a full and widespread discussion of problems relating to Alzheimer’s disease and similar conditions, together with the Scottish Executive, medical professionals, health and social work managers and people with Alzheimer’s disease and those caring for them, in order to seek out a consistent and rational approach to treating such conditions.

Relief from early stages of Alzheimer’s – Michael Matheson (SNP – Central Scotland) the Parliament notes with regret the decision of the National Institute of Health and Clinical Excellence not to recommend that drugs such as Aricept, used to treat Alzheimer’s disease, are made available for wider use, and calls on the Scottish Executive and NHS Quality Improvement Scotland not to subscribe to this decision which would restrict access to drugs that have been shown to slow the effects of Alzheimer’s disease in its early stages.

Alzheimer’s drug treatments – Irene Oldfather (Lab – Cunninghame South) the Parliament regrets the recent announcement by the National Institute for Health and Clinical Excellence (NICE) that it has rejected all appeals and that drugs to treat Alzheimer’s disease will in future only be available on the NHS to people with moderate Alzheimer’s disease; recognises that this means that people with mild Alzheimer’s disease will no longer be eligible for treatment; notes that the current cost of the treatments is less than 0.3% of the total NHS Scotland drugs budget; is aware, however, that these treatments have been assessed by the Scottish Intercollegiate Guidelines Network as clinically effective at all stages of Alzheimer’s disease; notes that memantine, currently widely prescribed across Europe and the United States of America for the treatment of severe Alzheimer’s disease, is also not being recommended for use; acknowledges that the Royal College of Psychiatrists and the Royal College of General Practitioners also believe that these drugs are effective treatments in improving quality of life for people with Alzheimer’s disease; is concerned that NICE’s appraisal focused solely on statistical, clinical and cost-effectiveness information and did not take into account the wider positive impact that these drugs can have on the lives of people with Alzheimer’s disease and their families, including maintaining independence for longer and alleviating the impact of the disease on carer’s own health and quality of life; notes that NICE’s decision applies in England and Wales and takes effect on 22 November 2006; is aware that NHS Quality Improvement Scotland (QIS) will publish its comment on the guidance on that date, which will then set the rules for NHS boards in Scotland, and calls on the Scottish Executive to listen to the views of patients, carers and clinicians alike, as well as any guidance from NHS QIS, and consider adopting a different position in Scotland to allow people at all stages of Alzheimer’s disease to continue receiving the medication that their GP or consultation recommends.

MINISTERS QUESTION TIME

Alzheimer drug treatments – 9 November

Donald Gorrie (LD – Central Scotland) asked if the Minister would reconsider and extend the use of the drugs for people in the mild stages of Alzheimer’s disease.

The Deputy Minister for Health and Community Care, Lewis Macdonald understands that NHS Quality Improvement Scotland will recommend shortly that the drugs should be used only for the treatment of moderate Alzheimer’s disease and they will no longer be recommended for people in the early and mild stages of the disease.

David Davidson (Con – North East Scotland) asked whether this decision was budget driven or if the Scottish Executive disagreed with the policy that the expert prescriber should be the person who decides the best medication for an individual.

Lewis Macdonald replied that it was not about side-stepping the views of the expert prescriber; it is about providing a framework within which decisions are made, which is informed by the best available science. They are judgements for scientists rather than for ministers.

Alzheimer drug treatments – 16 November

Dr Elaine Murray (Lab – Dumfries) said that the Minister would be aware that carers and people with Alzheimer’s disease are campaigning for NICE recommendations not to be followed in Scotland. Asked if the Minister would follow the policy of the many other countries that make these drugs available to all stages of Alzheimer’s disease, instead of following England and Wales.

Lewis Macdonald said that he was aware of the campaign. However, it is a matter for NHS Quality Improvement Scotland. It would not be appropriate for the Executive to second guess the scientific advice.

PARLIAMENTARY DEBATE

Adult Support and Protection (Scotland) Bill – 23 November
The stage one debate on this Bill was held in the Parliament on 23 November. The Bill is intended to fill the gaps that remain after the Adults with Incapacity (Scotland) Act 2000 and the Mental Health (Care and Treatment) (Scotland) Act 2003. Its aim is to address the vulnerability of those who are mentally well and capable but who are nonetheless frail and at risk of harm by providing safeguards from deliberate and unintended harm.

The Parliament agreed to the general principles of the Bill and it will now be considered in detail by the Health Committee.

Lindsay Kinnaird – lkinnaird@alzscot.org