Presentation (CTI)

OBJECTIVES: In the UK, licensed DMTs for AD are not currently recommended by NICE and are therefore unavailable to patients on the NHS. Despite proven clinical efficacy in slowing cognitive decline, the Incremental Cost-Effectiveness Ratios (ICERs) exceeded the £20,000-£30,000 threshold. Critics argue the NHS and personal social services (PSS) perspective (the "Reference Case") systematically undervalues DMTs by excluding broader economic impacts, with informal dementia care currently estimated to cost the UK economy ~£21 billion annually. This research evaluates the impact of including wider societal costs on cost-effectiveness estimates as well as exploring the reasons why NICE are yet to allow flexibility for inclusion of these costs.
METHODS: An analysis of the NICE appraisal documents for lecanemab and donanemab was completed to assess the impact on the ICERs when comparing the Reference Case versus Non-reference case (societal costs). Furthermore, the deliberations of the committee and external assessment group (EAG) were assessed to identify drivers for decisions on allowing these flexibilities.
RESULTS: Our analysis shows including non reference case societal costs lowered ICERs, yet NICE rigidly rejected them due to its strict government-mandated perspective; excluding wider societal costs unless explicitly directed otherwise. This work indicates that accounting for societal costs improves cost-effectiveness of DMTs. Acknowledging these costs is crucial because the true value of delaying progression lies not just in direct medical savings, but in significantly reducing the burden placed on unpaid family carepartners.
CONCLUSIONS: Current NICE value frameworks underestimate the economic impact of AD DMTs by excluding wider societal costs, particularly the burden on unpaid carers. To ensure UK patients gain equitable access to innovative treatments, NICE must be enabled by the UK government to adopt flexibility, evolving from a "siloed" health system perspective towards a "societal-readiness" model, accounting for the full societal impact of neurodegenerative diseases like AD.