TY - JOUR

T1 - Cholinesterase inhibitors for Alzheimer's disease

T2 - Variations in clinical practice in the north-west of England

AU - Purandare, Nitin

AU - Swarbrick, Caroline

AU - Fischer, Alastair

AU - Burns, Alistair

PY - 2006/10

Y1 - 2006/10

N2 - Background: In the UK, the National Institute for Health and Clinical Excellence (NICE) is currently reviewing cost-effectiveness of cholinesterase inhibitors (ChEIs) for Alzheimer's disease (AD) in the NHS. The implementation of the original NICE (2001) guidance that made these drugs available in the UK was not examined in this review process, and was the objective of this study. Method: Ten hospitals in and around Manchester participated in the audit. Case records of all patients who were started on ChEIs between January 2002 and the date of the audit (November 2003 to December 2004) were examined to assess adherence to the NICE (2001) guidance. Information about available resources was gathered from lead clinicians of each hospital. Results: A total of 1092 case records were examined. The treatment of AD with ChEIs varied considerably with regard to pre-treatment investigations, waiting period for treatment, scales used to assess efficacy, adherence to the NICE (2001) guidance, and available resources. The actual number of patients with mild to moderate AD receiving ChEIs was much lower than that expected from known prevalence rates. Non-uniformity of clinical practice and missing data were the main limitations of the audit. Conclusion: There is a need to harmonise the use and monitoring of ChEIs for AD in the NHS so that the data from routine clinical practice could feed into future clinical and cost-effectiveness analyses. Copyright © 2006 John Wiley & Sons, Ltd.

AB - Background: In the UK, the National Institute for Health and Clinical Excellence (NICE) is currently reviewing cost-effectiveness of cholinesterase inhibitors (ChEIs) for Alzheimer's disease (AD) in the NHS. The implementation of the original NICE (2001) guidance that made these drugs available in the UK was not examined in this review process, and was the objective of this study. Method: Ten hospitals in and around Manchester participated in the audit. Case records of all patients who were started on ChEIs between January 2002 and the date of the audit (November 2003 to December 2004) were examined to assess adherence to the NICE (2001) guidance. Information about available resources was gathered from lead clinicians of each hospital. Results: A total of 1092 case records were examined. The treatment of AD with ChEIs varied considerably with regard to pre-treatment investigations, waiting period for treatment, scales used to assess efficacy, adherence to the NICE (2001) guidance, and available resources. The actual number of patients with mild to moderate AD receiving ChEIs was much lower than that expected from known prevalence rates. Non-uniformity of clinical practice and missing data were the main limitations of the audit. Conclusion: There is a need to harmonise the use and monitoring of ChEIs for AD in the NHS so that the data from routine clinical practice could feed into future clinical and cost-effectiveness analyses. Copyright © 2006 John Wiley & Sons, Ltd.

KW - Alzheimer's disease

KW - Cholinesterase inhibitors

KW - Clnical practice

U2 - 10.1002/gps.1591

DO - 10.1002/gps.1591

M3 - Journal article

VL - 21

SP - 961

EP - 964

JO - International Journal of Geriatric Psychiatry

JF - International Journal of Geriatric Psychiatry

SN - 0885-6230

IS - 10

ER -