First Alzheimer’s treatment to be funded

First Alzheimer’s treatment to be funded

People with Alzheimer’s Disease and other forms of dementia will have access to a funded medicine for the first time, following a decision by PHARMAC.

PHARMAC will fund the Donepezil-Rex brand of donepezil, once it is registered for use in New Zealand by Medsafe. The exact date funding will begin hasn’t been established, but will be after 1 July 2010.

Donepezil is one of the acetylcholinesterase inhibitor group of medicines, specifically used to treat Alzheimer’s disease and related types of dementia. None of these treatments are currently funded in New Zealand.

Medical director Dr Peter Moodie says that PHARMAC has always recognised the impact of Alzheimer’s disease on patients, their families and caregivers, and the need for a funded treatment that was effective and provided value for money. However, before competition enabled a price reduction, the acetylcholinesterase inhibitors would have crowded out funding for other medicines, consuming up to $32 million of funding for relatively small clinical benefits.

Dr Moodie says there is evidence to show acetylcholinesterase inhibitors like donepezil can slow the progression of Alzheimer’s disease in some patients. However, those patients who might benefit are difficult to identify before treatment begins, so it is difficult to effectively target these treatments.

“This, combined with the relatively high cost of the acetylcholinesterase inhibitors, has made it very difficult to justify funding these drugs until now,” he says. “While they have benefits for some patients, we would have been funding many others at a high cost for no benefit. Overall this would have led to very poor cost-effectiveness and lost opportunities to fund other medicines.”

This led to PHARMAC declining funding for acetylcholinesterase inhibitors in 2004.

However, a substantial price reduction for donepezil following a competitive process run by PHARMAC has changed the landscape, says Dr Moodie. PHARMAC will be paying about 5% of the price of other brands of donepezil, once Donepezil-Rex is listed.

“With this significantly lower price, donepezil is now more cost-effective than some other funding choices we could make,” says Dr Moodie.

Donepezil will be funded without restrictions, meaning it can be prescribed and funded for anyone with Alzheimer’s disease or other types of dementia.

PHARMAC estimates that donepezil will be used by about 15,000 people after three years, at a cost of approximately $680,000 per year.

Meanwhile, PHARMAC has also declined funding for memantine (Ebixa), which belongs to a different class of medicines and is used to treat Alzheimer’s disease. Dr Moodie says PHARMAC’s clinical advisory committees thought memantine had poor evidence of effectiveness, and it was also not cost-effective.

Dr Moodie says PHARMAC remains open to funding other treatments for Alzheimer’s disease, including other acetylcholinesterase inhibitors, should acceptable terms be reached with suppliers.

Alzheimers New Zealand’s national director Johan Vos says the organisation is delighted with the outcome.

“The subsidy of this medication will make a substantial change to the people we are working for. We have advocated for over 10 years to make this happen. It enables a person who is diagnosed to have increased cognitive function, a prolonged quality of life and to better prepare them for their journey ahead. It can also delay entrance to a residential care facility to enable people to stay in their homes longer.”

ENDS

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