Alzheimer's: Would new donanemab be available on the NHS and how much could it cost?

Full results for the donanemab drug have shown that it has the capacity to slow the progression of Alzheimer's in patients, in what has been described as a "groundbreaking" development by health experts.

Clearing a protein that causes this type of dementia from the brain, the drug will slow a person's cognative decline - although it is not a cure for the disease.

A global trial has already taken place, and the National Institute for Health and Care Excellence (NICE), UK's drugs watchdog, is considering the drug for possible use on the NHS.

But how likely is it that the drug will be made available through the NHS - and how much could it cost?

Supply vs demand

At the moment, there are roughly 900,000 people living with dementia in the UK - and Alzheimer's is the most common form of the disease.

According to the London School of Economics and Political Science (LSE), this number is expected to rise to 1.6m by the year 2040. In the donanemab trial, patients received a monthly infusion, meaning that if it was available on the NHS, the UK would need 10.8m units of the drug per year, based on current figures.

If the LSE study, commissioned by the Alzheimer's Society, proves accurate, then by 2040 the UK would need almost 20m units of the drug every year.

But other countries will also want access to this "groundbreaking" drug, and so availability will subsequently boil down to whether the manufacturer, Eli Lilly, can keep pace with what will inevitably be a global demand for donanemab.

A rare precedent

If NICE does approve donanemab for NHS use, it would not be the first time that a game-changing drug has been made available through our National Health Service.

In 2019, NHS England secured a deal for three cystic fibrosis medicines, all developed by Vertex Pharmaceuticals.

Matt Hancock, who was Health Secretary at the time, said: "The deal is great value for money for the NHS, and crucially, will improve thousands of lives. This deal – on the back of several others this summer – shows why we get some of the best value drugs in the world, and is another reason to be so proud of our NHS.”

NHS England's Long Term Plan at the time stated that investing in "world-class, cutting edge technologies and treatments" was a core part of the NHS' future. Assuming that this remains the case, there is certainly a precedent for the NHS to take these rare medical breakthroughs and make them widely available for patients.

How much will it cost?

If donanemab becomes available on the NHS, then it won't cost a penny to the patients.

However, if NHS England negotiates a deal for the drug then it will likely cost the institution a significant amount of money - especially considering how strong the demand will be.

A NICE spokesman said: "NICE has already started work on its appraisal of donanemab for treating mild cognitive impairment or mild dementia caused by Alzheimer’s disease. Our aim is to produce recommendations on its use in the NHS as close as possible to it receiving its UK licence. We estimate guidance on donanemab could be ready as early as the middle of next year. To do this we are already talking to NHS England and the company.

“The value of health to society, and the impacts it has on people, families and society, underpins what we do, and why it is critical that we support evidence-based access to medicines that represent a cost-effective use of NHS resources.

“Whether a medicine is recommended by NICE is influenced by many factors including the evidence on how well it works but importantly also by its price, which is set by the company. It will also be important during our evaluation of donanemab to understand the services required by the NHS to deliver it and how those eligible for treatment will be identified.”