NICE Ordered to Reconsider Alzheimer's Drugs After Successful Appeals by Eli Lilly and Eisai
Key Insights
NICE must reconsider its rejection of NHS reimbursement for Eli Lilly's Kisunla (donanemab) and Eisai's Leqembi (lecanemab) following successful appeals by the manufacturers.
The appeals panel found issues with NICE's consideration of unpaid carer costs, caregiver quality of life evidence, NHS infusion cost estimates, and long-term drug data.
Both treatments are targeted antibody therapies that bind to amyloid (search) protein and have been shown to delay Alzheimer's progression by four to six months.
The UK's National Institute for Health and Care Excellence (NICE) has been ordered to reconsider its decision blocking NHS access to two breakthrough Alzheimer's disease (search) treatments following successful appeals by pharmaceutical manufacturers Eli Lilly and Eisai.
The appeals panel ruled that NICE must take another look at its rejection of Lilly's anti-amyloid (search) antibody Kisunla (donanemab) and Eisai's similarly-acting Leqembi (lecanemab), which were denied NHS reimbursement in June 2025 after an unprecedented third appraisal.
Appeal Grounds and Key Issues
According to Lilly, NICE's committee will now re-examine several critical issues including the consideration of unpaid carer costs, conclusions on evidence relating to caregiver quality of life, considerations regarding NHS infusion cost estimates, and long-term data for the drugs.
The pharmaceutical firms argued that documentation detailing infusion costs was only provided four days before the third committee meeting, leaving insufficient time for adequate scrutiny of the evidence.
Helen Knight, director of medicines evaluation at NICE, acknowledged that "the independent appeal panel has ruled that some elements the committee used to inform its decision-making in relation to the cost effectiveness of donanemab and lecanemab need further consideration."
Treatment Mechanisms and Clinical Benefits
Both donanemab and lecanemab are targeted antibody treatments that bind to amyloid (search), a protein that accumulates in the brains of Alzheimer's sufferers. This process helps clear the build-up and reduces the rate of cognitive decline, marking a significant breakthrough as they address the underlying cause of the condition rather than just symptoms.
NICE's original assessment found that the treatments delay progression from mild to moderate Alzheimer's by four to six months. However, the watchdog concluded the medicines could not be provided on the NHS because they were not good value for money and "only provide modest benefits at best."
The treatments were estimated to cost five to six times more than the threshold NICE can normally recommend. A lack of evidence on long-term effects and the need for intensive patient monitoring for side effects were cited as main reasons for the initial rejection.
Industry and Advocacy Response
"This is a big moment in the battle against Alzheimer's disease (search)," said Chris Stokes, general manager of Lilly's Northern European Hub headquarters in Basingstoke. "NICE was right to look again at the evidence in front of them. For people living with Alzheimer's disease, and for the families and carers who support them, this matters, perhaps now more than ever."
An Eisai spokesperson added: "This news offers a welcome glimmer of hope for the Alzheimer's disease (search) community in England. We are keen to work quickly with Nice to assess this treatment effectively, because whilst we wait, Alzheimer's disease does not."
Alzheimer's Research UK (search) welcomed the decision, with David Thomas, the charity's head of policy and public affairs, stating: "While these treatments offer modest benefits and can cause serious side effects, they provide the foundation for a future where dementia becomes a treatable condition."
Broader Healthcare System Challenges
The Alzheimer's Society (search) had previously called the June 2025 decision a "setback," but noted that even if the drugs had been recommended, "too many patients wouldn't be able to access them because the health system isn't ready to deliver them."
Michelle Dyson, chief executive at Alzheimer's Society (search), responded to the appeal outcome: "We welcome Nice's decision to look again at the case for lecanemab and donanemab, particularly at the significant impact of dementia on unpaid carers. We know that carers are too often pushed to breaking point and this needs to be properly recognised."
Next Steps and Timeline
The timeframe for the next NICE meetings to discuss the drugs remains to be set, and it is uncertain whether follow-up hearings will change NICE's position on access. The appeals panel indicated there is no possibility of further action through NICE's channels, meaning any additional legal action would need to go through the High Court within three months of NICE publishing final guidance.
Dyson noted the urgency of the situation: "The science is moving fast and globally more people are starting to access these drugs, but the UK is falling behind. With over 30 Alzheimer's disease (search) drugs in late-stage clinical trials, there are likely to be more treatments submitted for approval soon."