NHS Rejects Donanemab and Lecanemab in Final Draft Alzheimer’s Guidance

Introduction

The NICE appraisal committee reviewed clinical data and concludes that donanemab and lecanemab cannot be recommended for mild cognitive impairment or mild dementia caused by Alzheimer’s disease. Stakeholders have until 3 July to appeal the decision.

Clinical Benefits vs Cost

Both drugs have been shown to delay progression from mild cognitive impairment to moderate Alzheimer’s by approximately 4–6 months. However, the committee found these benefits too limited to justify their high cost, including administration expenses. Continued use would divert NHS resources from other effective services.

Committee Assessment

Helen Knight, Director of Medicines Evaluation at NICE, said:

“We have done everything we possibly can to try and achieve a positive outcome in our assessments of these treatments, including providing an additional opportunity for new evidence to be submitted.” (nice.org.uk)

She acknowledged that even a modest slowing of decline could be meaningful for patients and carers, but the committee concluded the effect was too small, combined with substantial NHS resource requirements, to approve these treatments.

Next Steps

The committee reviewed new consultations and additional evidence but maintained its position that neither donanemab nor lecanemab represents value for the NHS. Their implementation could potentially displace more effective services. Stakeholder responses will inform the final guidance expected later this year.

Citation:
National Institute for Health and Care Excellence. (2025, 19 June). Final draft guidance finds benefits of 2 Alzheimer’s treatments remain too small to justify the additional costs to the NHS. NICE