Who will be eligible? An investigation of the dementia population eligible for cholinesterase treatment following the change in NICE guidance.
OBJECTIVE
Investigate the impact of the changes in eligibility within England and Wales (E&W) for prescription within the UK National Health Service for treatment of Alzheimer's disease (AD).


METHODS
A population-based study in England and Wales with 13,004 individuals measured with MMSE at baseline was used to examine the distributions of individuals within eligibility criteria. Information obtained from informants enabled classification of the study defined dementia cases to ICD10 diagnosis of subtype (AD, dementia with vascular risk, both or other).


RESULTS
Fifty six per cent of dementia patients (representing 323,000 individuals in E&W) fall into the new MMSE criteria band. A further 120,000, 20% of dementia patients, are estimated to have disease that is considered too mild for treatment. Further examination of type of dementia showed that those with mixed AD and vascular dementia had similar proportions of dementia cases within the treatable MMSE group as the subgroup with AD alone, though with mixed disease individuals more often score below the lower threshold. There is substantial instability in the eligibility groupings over a short time period.


CONCLUSIONS
The population impact of new NICE criteria of excluding high MMSE scores is to exclude one in five individuals with AD and a further one in ten of those with a mixed disease. Changing the guidance has almost balanced the loss of treatment for the high MMSE group (13%) with the introduction of treatment for those scoring 10/11 (11%).
Matthews
Fiona E
FE
MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK. Fiona.matthews@mrc-bsu.cam.ac.uk
Muniz-Terrera
Graciela
G
McKeith
Ian
I
Brayne
Carol
C
D000368:Aged; D000369:Aged, 80 and over; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003704:Dementia / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D015995:Prevalence; D013222:State Medicine; D014852:Wales / Q000453:epidemiology
D002800:Cholinesterase Inhibitors