The 2 medications, lecanemab and donanemab will be reassessed for NHS use following successful appeals from their manufacturers.
Last year, the National Institute for Health and Care Excellence (NICE) concluded that lecanemab and donanemab should not be funded by the NHS for patients with mild cognitive impairment or early-stage Alzheimer’s disease. NICE had determined that the treatments were not a cost-effective use of limited healthcare resources.
The drugs are administered through infusions and require intensive monitoring for potential side effects such as brain swelling and bleeding. It was estimated to cost up to 6 times more than NICE’s usual threshold for approval.
Clinical trials showed they could delay disease progression by up to 6 months.
The reassessment comes after independent panels upheld appeals from the pharmaceutical companies. NICE has already rejected several appeals prior to their decision in June 2025.
It is believed that after 3 years, there is no difference between those who have received the treatment and others who have not. It also costs up to £80,000 per year per patient.There is no extra funding allocated to provide these services so would have to be resourced from the same funding leading to the risk of other services being cut.
The arguments included the societal benefits such as burden of carers. Informal dementia care is estimated to cost the UK economy at least £20billion per year.
The reassessment will take place under the newly introduced cost-effectiveness thresholds, agreed as part of a UK-US trade deal.
UK-US trade deal was agreed upon in late 2025. The Old Rule: For 20 years, NICE generally capped spending at £20,000–£30,000 per “Quality Adjusted Life Year” (QALY). The New Rule: As of April 2026, that limit rises to £25,000–£35,000. This is still far off the lower estimate of £60,000 per year.
Both lecanemab and donanemab are monoclonal antibodies and work by targeting amyloid beta proteins in the brain. The substances believed to form plaques that contribute to Alzheimer’s disease. These proteins clump together to form “plaques” that disrupt brain function. By binding to these plaques, the drugs help the body clear them away.
While it remains uncertain whether NICE will ultimately reverse its decision, the reassessment underscores a key challenge facing modern healthcare systems: how to balance the promise of innovation with the realities of finite budgets.
The next NICE meeting to discuss this is believed to be this summer, 2026 with the updated Draft Guidance, later this year. The final guidance is expected early next year, 2027.
What about the cost of these appeals and the person power, working hours working on this appeal? May have been money better spent on providing the treatment in the first instance.
There really needs to be a good look at how much time and effort is spent on these QALY assessments for NICE to see if there is a more efficient way.