The National Institute for Health and Care Excellence closed its consultation on lecanemab and donanemab on April 28; the next committee meeting is scheduled for June 10. [1] Manufacturers Eisai, Biogen, and Eli Lilly expect a revised cost-effectiveness threshold — adopted by NICE in March 2026 — to apply to this round of appraisal. [1] The Cochrane review of anti-amyloid monoclonals is the freshest evidence on the table. [2]

The paper named the cost-effectiveness threshold last week as the variable separating the previous rejection from the new appraisal. NICE has historically run an upper limit between £20,000 and £30,000 per quality-adjusted life year; the March update lifted that ceiling for end-of-life and severe-disease indications under conditions documented in its methods manual. [3] Whether Alzheimer's disease meets those conditions is the committee's question — the manufacturers' answer is yes, NHS England's actuarial position will not be public until after June 10.

What June 10 produces is the first NICE recommendation to apply the new threshold to a high-cost, large-population indication. The signal travels — to Scotland's SMC, to Ireland's NCPE, to Australia's PBAC, and indirectly to CMS, which is watching how British actuaries price 18-month delays in cognitive decline against a £25,000-per-QALY ceiling that is no longer hard.

The paper's GLP-1 thread asked who pays. The Alzheimer's thread asks the same question with a slower clock.

-- KENJI NAKAMURA, London