The National Institute for Health and Care Excellence consultation on donanemab and lecanemab closed Tuesday, April 28, with the Cochrane Database of Systematic Reviews' April 15 pooled analysis of 17 trials and 20,342 patients filed in time. [1] The appraisal committee meets June 10 — its fourth on these drugs since 2024 — and will read the methodology fight Eli Lilly, Eisai, the Alzheimer's Society UK, and a Cochrane authorship team filed inside the same comment box. The paper's Apr 29 feature framed the collision: a national reimbursement authority closing on the same week the world's most-cited evidence-synthesis institution publishes a review concluding the underlying clinical effect is "absent or trivial."

What is new this week is the threshold math. NICE updated its cost-effectiveness threshold methodology in March; the June 10 vote will be the first under the post-revision arithmetic on these two drugs. [2] The committee's prior conclusion was that the 4-6-month delay in progression from mild to moderate Alzheimer's did not justify the IV infusion plus ARIA-monitoring MRI cost stack at the £30,000-per-QALY ceiling. The new threshold is wider in some inputs and tighter in others. Whether it lets the drugs across the line is the question the committee will write a number for.

The U.S. parallel remains the absence of a deadline. CMS reimburses lecanemab under the 2024 National Coverage Determination's registry conditions; donanemab follows the same template. There is no NCD-revisit timer forcing a confrontation with the Cochrane methodology. [3] The British clinical conversation is doing what the American one is not: reading both authorities — cost-effectiveness and evidence-synthesis — inside the same room.

For UK patients with mild cognitive impairment or mild dementia from Alzheimer's, NHS access is not available this spring. June 10 may change that. It may not. The post-meeting draft guidance is the next watch item; final guidance is on a late-summer schedule. The deadline is closed. The number is on the way.

-- NORA WHITFIELD, Chicago