Patients 'face postcode lottery' over Alzheimer's drugs » Health » 24dash.com

Alzheimer's patients face a postcode lottery in accessing key drugs, data out today suggests.

There is wide variation across England in who gets cholinesterase inhibitors, such as donepezil, rivastigmine and galantamine, it showed.

The drugs are only approved for use on the NHS in people with moderately severe Alzheimer's disease.

That decision by the National Institute for Health and Clinical Excellence (Nice) in 2007 caused outrage among campaigners.

Snapshot data published today by IMS Health, and reported in GP newspaper, showed lowest use of the drugs in the South West and West Midlands, with the highest in the North West and South Central regions.

Across England, regional variations could be as much as 70%.

The overall use of the drugs has increased in the UK over the last three years (by 33% from the year ending September 2006 to the year ending September 2008), but the UK still lags behind other countries, the figures showed.

Use of the drugs in the UK falls below Germany (where usage is 18% above that in the UK), Sweden (44%), Austria (81%) and Spain (148%).

Today's data also suggests one in five UK prescriptions for dementia drugs are still for anti-psychotic treatments, which are designed to cut aggression and reduce psychotic symptoms such as delusions.

These so-called "chemical cosh" drugs are widely used in care homes and are also called anti-Alzheimer's drugs.

Today's data is limited to prescriptions picked up from community pharmacies, which probably does not cover care homes, the Alzheimer's Society said.

But it said the figures were helpful in providing estimates of the number of people on the drugs.

Professor Steve Iliffe, professor of primary care for older people at University College London, told GP: "The UK is probably under-prescribing anti-Alzheimer's drugs because PCTs are using the Nice guidance to restrict the use of the drugs."

Professor Clive Ballard, director of research at the Alzheimer's Society, said anti-psychotic prescribing remained "inappropriately high"
and should only be used to treat severe symptoms or in exceptional circumstances and for short periods.

Neil Hunt, chief executive of the charity, added: "Anti-psychotics can double risk of death, triple risk of stroke and accelerate symptoms in people with dementia.

"It is absolutely disgraceful that so many people across the UK are inappropriately prescribed these drugs.

"Anti-psychotics should only be used to treat severe symptoms in exceptional circumstances and only for short periods.

"Specialist dementia training vastly increases quality of life and could save the UK £35 million a year if it was mandatory."

He called on the Government to publish its long-awaited review of anti-psychotic drugs, which has been delayed for more than seven months.

The data comes as a sociologist from the US said there was too much reliance on drugs.

Speaking at the Cheltenham Science Festival yesterday, Dr John Zeisel, who has published a book on treating Alzheimer's without the use of drugs, said: "We need a complete sea change in attitudes towards Alzheimer's if we are to even begin to respond to this growing health crisis, which is expected to double in the UK alone within a generation.

"My own research and practice across the world, as well as the work of many other scientists has proved that non-pharmacological treatment of Alzheimer's, such as environmental design responsive to their capacities, caregiver education, visits to museums with research-based selection of art works and specially trained guides, and simply being engaged in pleasant activities, can be just as powerful as other medicinal treatments in reducing symptoms of dementia and the big four As of Alzheimer's: agitation, anxiety, aggression, and apathy.

"Current attitudes to Alzheimer's are woefully outdated and could be compared to the way that epilepsy or autism was viewed in the 19th century."

A spokesman for the Department of Health said: "Guidance to health and care professionals is very clear: anti-psychotic drugs should only be used appropriately as part of best clinical care practice.

"Our review into the use of anti-psychotic drugs for dementia has received a lot of feedback from a range of organisations.

"We are carefully considering all the feedback before reaching any conclusion. The outcomes of this review will be completed shortly.

"We published the National Dementia Strategy to help transform dementia services, for example by creating more memory clinics, improving training of GPs and creating dementia advisers to help guide people with dementia and their carers through the care system."