IPM Take
This is not only about two Alzheimer’s drugs. It is about whether HTA systems are ready for the new economics of neurodegenerative disease. NICE is being pushed to reconsider not just clinical effect, but infusion costs, carer quality of life and unpaid care. As Alzheimer’s treatment moves earlier in the disease pathway, value assessment can no longer focus only on the treated patient inside the clinic. It also has to account for the system, the family and the care economy around them.
Executive Summary
NICE will reconsider lecanemab and donanemab after appeal panels upheld grounds of appeal against previous final draft guidance. In June 2025, NICE had not recommended either therapy for routine NHS use, concluding that the benefits in people with mild cognitive impairment or mild dementia caused by Alzheimer’s disease did not justify the additional cost to the NHS. The lecanemab appeal was upheld on points related to carer utility values and time to respond to NHS England’s infusion cost estimates. The donanemab appeal was also remitted after upheld appeal points, with NICE later opening a further consultation. NICE’s in-development pages state that a committee discussion for both topics was scheduled for 8 July 2026.
Why it matters
- HTA bodies: Need to refine how value frameworks handle carer quality of life, unpaid care and system delivery costs for disease-modifying dementia therapies.
- Payers / public authorities: Must prepare for therapies that require early diagnosis, amyloid confirmation, infusion services and monitoring, even if reimbursement remains contested.
- Patients / advocates: Should watch whether reconsideration changes access or simply confirms that the NHS pathway is not yet ready to fund and deliver these therapies at scale.
Before this appeal outcome, the UK position was clear: lecanemab and donanemab were clinically important, but not cost-effective enough for routine NHS use. That created a visible access divide between regulatory authorisation, private access and public reimbursement.
What has changed is not yet a positive recommendation. NICE has not approved the drugs for routine NHS use. Instead, the appeal process has forced the appraisals back to committee on specific methodological and procedural points. For lecanemab, the appeal decision says the appraisal was remitted so the committee could reconsider carer utility values and allow stakeholders adequate time to respond to NHS England’s infusion cost estimates. For donanemab, NICE’s consultation document states that the final draft guidance was remitted after four upheld appeal points and that stakeholders were asked to comment on long-term extension data and NHS England’s infusion cost estimates.
The eligible population under discussion is narrow: adults with mild cognitive impairment or mild dementia caused by Alzheimer’s disease, within each product’s marketing authorisation. That makes early diagnosis and biomarker-supported pathway readiness central to access.
The implication is bigger than the two products. Alzheimer’s therapies come with a heavy delivery model: early identification, amyloid confirmation, infusion capacity, monitoring for adverse effects and specialist follow-up. If more disease-modifying dementia therapies arrive, HTA bodies will need stronger ways to judge caregiver impact, system costs and the value of delaying decline.
