ABSTRACT
Concerns about the high cost of health
and social care are compounded by the
introduction of pharmaceutical products such
as the acetylcholinesterase inhibitors. Currently,
these drugs are considered to be the most
successful agents for the management of
dementia, primarily Alzheimer’s disease
(Burns et al, 1999). Second-generation
cholinesterase inhibitors (e.g. donepezil,
rivastigmine) have been reported to have
similar efficacy and safety results, in terms of
improved cognitive function and delayed
progression of disease in some patients. The
National Institute for Clinical Excellence
(NICE) has recommended that three drugs
should be made available on the National
Health Service for people with mild to
moderate Alzheimer’s disease and Mini-
Mental State Examination scores of 12 points
or more (NICE, 2001). However, NICE also
recognizes that there is significant uncertainty
about the costs of the drugs and associated
health and social care. This is compounded by
the fact that the value of the drugs to patients
and carers in terms of improved quality of life
is unclear (NICE, 2001).
